Can physicians bill the CGM CPT code 95250 for personal use CGM systems under the Medicare rules?

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No, healthcare professionals (HCPs) should not use CPT code 95250 (patient training, hook-up and calibration, sensor removal, data download) for personal use continuous glucose monitoring (CGM) for Medicare patients—this code can be used only for professional CGM services.  

If a physician or mid-level practitioner is interpreting personal or professional use CGM data they would bill under CPT code 95251. Services associated with CPT code 95251 may be a non-face-to-face service. 

If a physician or mid-level practitioner has office visits with a patient to discuss treatment changes based on personal or professional use CGM results, they should bill using Evaluation and Management (E/M) codes based on medical necessity and level of service provided. 

Office staff should consult with their payers for final coding advice.

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