CurrentBlue KCPolicy POL-PP-210

Ambulatory Continuous Glucose Monitoring

Defines billing, coding, and payment guidance for ambulatory continuous glucose monitoring services and related DME/supplies for Blue KC lines of business, affecting professional, facility and DME providers.

Policy Summary

PayerBlue KC

PolicyAmbulatory Continuous Glucose Monitoring

Policy CodePolicy POL-PP-210

Change TypeNo material changes

Effective DateDec 1, 2025

Next Review DateDec 1, 2026

Key ActionReport CPT 95251 only after documenting a minimum of 72 hours of CGM data and bill once per month for analysis and interpretation.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT codes described (95249, 95250, 95251)

2HCPCS device codes listed (E2102, E2103)

2Supply allowance codes (A4238, A4239)

72Minimum monitoring time (hrs)

KX / KSRequired modifiers

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Coverage and Billing Rules for Ambulatory CGM

Coverage and billing rules

Billing and coverage criteria and rules to support reimbursement for ambulatory CGM services, devices, and supplies.

ALL of the following

ALL of the following
- Report CPT 95249 when the patient provides the CGM data receiver and all elements in the CPT descriptor are completed: sensor placement, hook‑up, calibration of monitor, patient training, sensor removal, and printout of recording.
- CPT 95249 may not be reported more than once for the duration the patient owns the data receiver; obtaining a new sensor/transmitter without a change in receiver does not justify subsequent reporting.
- CPT 95249 may only be reported when the patient brings the data receiver to the provider's office and the entire initial data collection procedure is conducted in the office.
- The correct date of service for CPT 95249 is the date the CGM recording is printed in the office.
ALL of the following
- Report CPT 95250 when the provider supplies the CGM device and all CPT elements are completed: sensor placement, hook‑up, calibration, patient training, removal of sensor, and printout of recording.
- CPT 95250 is reportable once per month; the date of service is the date when all elements are completed.
- Modifier 52 may be used on 95250 to indicate monitoring for less than 72 hours; office notes may be required when modifier 52 is used.
ALL of the following
- Report CPT 95251 for analysis and interpretation of CGM data with a minimum of 72 hours of documented monitoring data.
- CPT 95251 may be billed once per month; the date of service is the date the interpreting clinician provided the written report with appropriate authentication and signature.
- An appropriate CGM analysis/interpretation report must include: patient identifiers, indication for placement, device name/type, sensor placement/removal dates (or start/end recording dates), date data was printed, analysis and interpretation, and signature of the interpreting clinician.
ALL of the following
- CPTs 95249, 95250, and 95251 are not approved telehealth services and should not be reported with place of service 2 or 10.
- Do not report CPT 99091 in addition to CPT 95249, 95250, or 95251; an E/M may be reported with CGM CPTs only when documentation supports a significant, separately identifiable E/M performed the same date.
ALL of the following
- Glucose monitoring time of 72 hours or more must be documented in the medical record to support billing of 95251 and related codes.
- CGM reports must document patient name, date of birth, medical record number, indication for device placement, device name/type, sensor placement/removal dates or start/end recording dates, date data printed, analysis and interpretation, and signature of the interpreting clinician.
ALL of the following
- For HCPCS device codes E2102 and E2103 and supply allowance codes A4238 and A4239, add modifier KX if the beneficiary is insulin treated or modifier KS if the beneficiary is non‑insulin treated on every claim submitted.
ALL of the following
- Codes defined: 95249 (patient‑provided, elements as above, minimum of 72 hours recorded), 95250 (physician/office‑provided, minimum of 72 hours, report once per month), 95251 (analysis/interpretation, minimum of 72 hours, report once per month), E2102/E2103 (adjunctive/nonadjunctive nonimplanted CGM or receiver), and A4238/A4239 (monthly supply allowance for adjunctive/nonadjunctive CGM).

ALL of the following

Date of service for 95249/95250: the date the CGM recording is printed or when all elements are completed; date of service for 95251: the date the interpreting clinician provided the written report.
Per Blue KC guidance, separate reimbursement will not be made for review of home CGM data using 95251; instead, an appropriate E/M may be billed in accordance with medical policy BKC-0126 when applicable.

ALL of the following

See Blue KC Medical Policy BKC-0126-v2 for clinical medical necessity criteria and additional policy details.

CPT and HCPCS Codes, Monitoring Duration

Covered CGM CPT/HCPCS codesmixedCovered

95249	Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; patient-provided equipment, sensor placement, hook-up, calibration of monitor, patient training, and printout of recording.
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.
95251	Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.
E2102	Adjunctive, nonimplanted continuous glucose monitor (CGM) or receiver.
E2103	Nonadjunctive, nonimplanted continuous glucose monitor (CGM) or receiver.
A4238	Supply allowance for adjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories; 1 month supply = 1 unit of service.
A4239	Supply allowance for nonadjunctive, nonimplanted continuous glucose monitor (CGM), includes all supplies and accessories; 1 month supply = 1 unit of service.

Minimum monitoring duration (inv-03)

Minimum monitoring durationMinimum 72 hours of CGM data required to bill CPT 95251 (analysis and interpretation); 72+ hours must be documented in the report.

Supporting documentationCGM report must include start and end dates of recording (documenting ≥72 hours), device name/type, sensor placement/removal dates, date data printed, analysis and interpretation, and interpreter signature.

Billing frequency95251 may be billed once per month when minimum 72 hours of data are present and documented.

Prior Authorization and Billing Actions

Billing Rule

Prior authorization / billing actions — follow CPT rules for reporting

Follow CPT reporting rules when billing ambulatory CGM services: use 95249 when the patient provides the data receiver and all elements (sensor placement, hook‑up, calibration, patient training, sensor removal, printout) are completed in office; 95249 may not be reported more than once while the patient owns the receiver. Use 95250 when the provider supplies the CGM equipment (reportable once per month). Use 95251 for analysis and interpretation when at least 72 hours of data are available (reportable once per month). For DME/device HCPCS (E2102, E2103) and supply codes (A4238, A4239), append modifier KX for insulin‑treated beneficiaries or KS for non‑insulin‑treated beneficiaries on every claim.

Do not report 95249 unless the patient brings the data receiver and all CPT elements are performed in the office; the date of service is the date the CGM recording is printed.
95250 is reported once per month; date of service is when all elements are completed.
95251 requires a minimum of 72 hours of data, is billed once per month, and the date of service is the date the interpreting clinician provided the written report.
Add modifier KX for insulin‑treated beneficiaries or KS for non‑insulin treated on E2102/E2103 and A4238/A4239 claims.

Key Terms and Billing Code Definitions

CGM — definition (inv-05)

DefinitionContinuous glucose monitoring (CGM) is a device system that automatically tracks interstitial glucose via a tiny subcutaneous sensor and transmitter and sends data to a monitor.

FunctionalityMeasures interstitial glucose continuously throughout the day and night and provides recorded data for analysis and interpretation.

ComponentsTypically includes a subcutaneous sensor, transmitter/receiver (or compatible receiver), and software/printout for data review.

Billing codes — short descriptions (inv-06)

95249Ambulatory CGM — patient‑provided equipment: sensor placement, hook‑up, calibration, patient training, sensor removal, and printout of recording; minimum 72 hours; may not be reported more than once while patient owns the receiver.

95250