Â鶹´«Ã½¸ßÇå

Professional CGM can be extremely useful, especially when personal CGM is not likely to be covered by insurance (e.g., if a patient’s situation doesn’t meet the criteria set by the insurer for personal CGM coverage). 

Advantages of Professional CGM include:

• Often easier path to get CGM data, especially when only desired intermittently
• Like personal CGM, may be more accurate than HbA1c in certain situations (e.g., anemia, hemoglobinopathies, CKD, etc.)
• No need or very limited need for insurance authorization
• May blind data from patient if there is concern about exposing so much to the patient
• Opportunity to cover/exceed expenses by enhancing revenue with separately billable procedures, which can be billed in addition to E/M if done on same day (details below) 

A practice can obtain a professional CGM system and sensors by purchase through the manufacturer or a supplier. 

• Each system requires a reusable reader for the practice to access to capture the data from the sensor, and they cost about $60-65; you will need at least one, though you may think about purchasing a spare, or one per pod—whatever works best for your practice and flow. 
• Each time you put a pro CGM sensor on a patient, you will need one disposable sensor; these cost about $60 each. 

Each of the manufacturers of professional CGM systems has useful information to describe and demonstrate application. 

Dexcom G6 Pro resources can be found here: 

Freestyle Libre Pro resources can be found here: 

Here too, each of the manufacturers of professional CGM systems has useful information to explain and demonstrate what you need to get the data. 

Dexcom G6 Pro resources can be found here: 

Freestyle Libre Pro resources can be found here: 

For traditional fee-for-service arrangements, two CPT codes can be used to bill and seek reimbursement for Pro CGM related services: 

• Professional CGM start
  • 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 and billed as often as every 90 days for most payers
    • 4.38 RVUs; typically pays $150 Medicare, $40 Medicaid, $309-453 Commercial; the RVU and reimbursement rates for this service are meant to provide professional compensation AND to cover or mostly defray the cost of the equipment
    • Can be in addition to E/M if both E/M and Pro CGM start performed on same day
• CGM Interpretation – billable later
  • CPT 95251: “Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; analysis, interpretation, and report.”
    • 1.02 RVUs; typically pays $35 Medicare, $19 Medicaid, $97-119 Commercial
    • Can be in addition to E/M if both E/M and Pro CGM interpretation performed on same day  

For FQHCs and RHCs, where traditional fee-for-service billing would not support reimbursement for Pro CGM, diabetes-related grant programs can be used to purchase Pro CGM systems and sensors to help defray the equipment costs.