Reimbursement and Coding for Dexcom G6 Pro
Commercial health insurers and government-sponsored plans provide more coverage for continuous glucose monitoring (CGM) systems now than ever before. Many reimbursement challenges that early adopters of CGM faced have been eliminated, supporting a more favorable reimbursement environment overall.
Learn more about the reimbursement process for Dexcom G6 Pro in the videos below.
To see costs and to order Dexcom G6 Pro, please visit our distributor, GEMCO.
What CPT codes can be billed for professional CGM?
This video provides details on CPT codes 95250 and 95251, which are billable services for professional CGM.*
Video length: 1 min. 37 sec.
Can CPT codes 95249, 95250, and 95251 be denied?
This video explains the reasons that CPT codes may be denied during the billing process, as well as steps healthcare providers can take to prevent this outcome.*
Video length: 1 min. 20 sec.
Do services associated with CPT codes 95249 and 95250 need to be provided face-to-face?
This video explains why professional CGM services associated with these CPT codes must be provided face-to-face.*
Video length: 28 sec.
Do services associated with CPT code 95251 need to be provided face-to-face?
This video explains why professional CGM services associated with this CPT code may be provided face-to-face or remotely.*
Video length: 41 sec.
Who can perform and bill CPT codes 95249 and 95250?
This video provides information on which types of healthcare providers are approved to perform and bill professional CGM services associated with these CPT codes.*
Video length: 1 min.
Who can perform and bill CPT code 95251?
This video provides information on which types of healthcare providers are approved to perform and bill professional CGM services associated with this CPT code.*
Video length: 26 sec.
What is the typical amount reimbursed for training on a personal CGM system, professional CGM system, and interpretation?
This video provides detailed information on how a physician’s fee schedule, payer type, and other factors can influence the reimbursement amounts for training and interpretation services associated with Dexcom G6 Pro.*
Video length: 1 min. 11 sec.
Which insurance companies are paying for CPT codes 95249, 95250, and 95251? How do healthcare providers find out the specifics of each insurance company’s CGM coverage policy and criteria?
This video provides an in-depth overview about insurance companies’ CGM coverage policies and criteria, as they pertain to use of Dexcom G6 Pro.*
Video length: 1 min. 13 sec.
|95250||Startup and training of a professional CGM (sensor placement, patient training, sensor removal, printout of recording).||Code is typically billed after patient has had sensor removed and when the CGM system is returned to the office by the patient.|
|95251||Analysis, interpretation, and recording of a professional CGM.||Code can only be billed a maximum of once a month. There must be a minimum of 72 hours of CGM data printed from the device that the patient was trained on in order to bill.|
*The reimbursement information provided is intended to assist you with billing for your services related to continuous glucose monitoring (CGM). It is intended for informational purposes only and is not a guarantee of coverage and payment. Providers are encouraged to contact their local payers with questions related to coverage, coding and payment. Rates provided under the Medicare PFS and OPPS are rounded to the nearest hundredth.
Frequently Asked Questions
Find the answers to frequently asked questions about Dexcom G6 Pro.