Wiki cpt 95251 requirement confusion- Endocrinology help

[marajade18]

Needing some help understanding cpt 95251 for a CGM download and interpretation of 72 hours of data. The guidelines say the code can only be billed once a month, do they mean a calendar month (as in; billed in Feb, can be billed again in March) OR does it have to be a full month between dates (billed 2/25, can't be billed again until 3/25)?? Can anyone provide some guidance on this issue?

 

[CBLENNIE]

You need to check your payer guidelines on the frequency for which they will allow 95251 to be billed. It appears based on a quick google search that many payers limit coverage of 95251 to 4 times per year. I didn't see anything defining a month as a 30 day period, so in theory you could bill it on 02/25 and then again on 03/05 because these are 2 separate months. However, I think the spirit of the restriction implies a month needs to pass before you can bill the code again, so every 30 days.

How often are your providers performing 95251 for each patient, are they doing it every month, or a semi-regular basis?