Effective Feb. 1, 2022, Clinical Pharmacist Practitioner (CPP) taxonomy code 1835P0018X will be allowed to bill and be reimbursed for:
CPT code 95249 - Ambulatory continuous glucose monitoring (CGM) 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. Reimbursement rate at $44.80.
CPT code 95250 - Ambulatory CGM 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. Reimbursement rate at $122.63.
Both codes are used for the technical component of CGM, and covers patient training, glucose sensor placement, monitor calibration, use of a transmitter, removal of sensor and downloading of data.
ICD-10 Diagnosis Codes must accompany the claim:
- E10.649 Type 1 diabetes mellitus with hypoglycemia without coma
- E10.65 Type 1 diabetes mellitus with hyperglycemia
- E10.69 Type 1 diabetes mellitus with other specified complication
- E10.8 Type 1 diabetes mellitus with unspecified complications
- E10.9 Type 1 diabetes mellitus without complications
- E11.649 Type 2 diabetes mellitus with hypoglycemia without coma
- E11.65 Type 2 diabetes mellitus with hyperglycemia
- E11.69 Type 2 diabetes mellitus with other specified complication
- E11.8 Type 2 diabetes mellitus with unspecified complications
- E11.9 Type 2 diabetes mellitus without complications
- E13.8 Other diabetes mellitus with unspecified complications
- E13.9 Other specified diabetes mellitus without complication
The CPP Fee schedule lists the reimbursement information for CPPs.
Contact
NCTracks Call Center: 800-688-6696