Coding for Remote Patient Monitoring and Continuous Glucose Monitoring

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Note: These tables are informational, not advisory. The AAFP recommends that physicians verify each payer's policy and ask patients to verify their coverage ahead of appointments.

What codes do I use for remote patient monitoring?

	Aetna	Elevance	Cigna	Humana	UHC	Medicare
CPT Codes: 99453-99454, 99457-99458, 99091
Place of Service (POS)	Use POS used for typical services (e.g., POS 11 – Office)	Commercial: Use POS used for typical services (e.g., POS 11 – Office) Medicare Advantage: Elevance policy not publicly available. Check with your local provider relations representative.	Use POS used for typical services (e.g., POS 11 – Office)	Commercial: Humana policy not publicly available. Check with your local provider relations representative. Medicare Advantage: Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)
Modifier	None	None	None	None	None	None

RPM Scenario Notes

Used to report remote patient monitoring during a 30-day period
Require at least 16 days of data
Can only be provided to established patients
Contact your Medicare administrative contractor for local requirements. Coverage and payment rates for private payers will vary by payer and a patient’s benefit plan. Check with your local provider relations representatives for their policies. Verify coverage for each patient.

What codes do I use for continuous glucose monitoriing?

	Aetna	Elevance	Cigna	Humana	UHC	Medicare
HCPCS Codes: 95250, 95221, 95249
Place of Service (POS)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)	Use POS used for typical services (e.g., POS 11 – Office)
Modifier	None	None	None	None	None	None

Personal CGM

CPT 95249: “Patient-provided equipment, sensor placement, hookup, calibration of monitor, patient training, and printout of recording”
May only be reported once during the time the patient owns the receiver
Patient must bring data receiver to the physician’s office with the entire initial data collection procedure conducted in the physician’s or other qualified health care professional’s office

Professional CGM Startup

CPT 95250: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; physician or other qualified health care professional (office) provided equipment, sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording”
May be performed by any qualified staff member under the direct supervision of a physician, physician assistant, or nurse practitioner
Must be reported with valid ICD-10-CM diagnosis code

CGM Interpretation

CPT 95251: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report”

May only be reported by a physician, nurse practitioner, or physician assistant

An evaluation and management (E/M) service can only be reported on the same date as CGM services if the E/M service is medically necessary and significant and separately identifiable from the CGM service. Append modifier -25 (Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service) to the E/M code when reporting CPT codes 95250 or 95251 on the same date.

Do not report CPT codes 95250 or 95251 more than once per month.

Coverage and payment rates for private payers will vary by payer and a patient’s benefit plan. Check with your local provider relations representatives for their policies. Verify coverage for each patient.