Coverage and Reimbursement
Medtronic offers professional reimbursement, service, and support for CareLink® Pro software.
Commonly Billed Codes
Medtronic Diabetes has developed this information to assist you in billing for your services related to the initiation and follow-up of patients who have been prescribed the MiniMed Paradigm® REAL-Time Revel System, consisting of the MiniMed Paradigm 523 or 723 Insulin Pump and REAL-Time Continuous Glucose Monitoring (CGM); the Guardian® REAL-Time System; or the iPro™ Professional CGM.
Medtronic provides this information for your convenience only. It is not intended as a recommendation regarding clinical practice. It is the responsibility of the provider to determine coverage and submit appropriate codes, modifiers, and charges for the services that were rendered. Please contact your local carrier or payor to verify coverage criteria and billing/coding guidelines.
CareLink With Continuous Glucose Monitoring (CGM)
ICD-9 Codes
Diagnosis codes are used by both physicians and hospitals to document the indication for the procedure or service performed.
The list below includes common ICD-9 diagnosis codes for Diabetes Mellitus.*
| ICD-9 | Description | Fifth Digit | |||
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | ||
| 250.0 | Diabetes mellitus without mention of complication | type II or unspecified type, not stated as uncontrolled | type I [juvenile type], not stated as uncontrolled | type II or unspecified type, uncontrolled | type I [juvenile type], uncontrolled |
| 250.1 | Diabetes with ketoacidosis | ||||
| 250.4 | Diabetes with renal manifestations | ||||
| 250.5 | Diabetes with ophthalmic manifestations | ||||
| 250.6 | Diabetes with neurological manifestations | ||||
| 250.7 | Diabetes with peripheral circulatory disorders | ||||
| 250.8 | Diabetes with other specified manifestations | ||||
| 250.9 | Diabetes with unspecified complication | ||||
* Excludes 250.2 and 250.3 series for diabetes with coma.
CPT/HCPCS II Codes for Provider Services
Providers use CPT (and certain HCPCS II) codes for all services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each code is assigned a point value, the relative value unit (RVU), which is then converted to a dollar payment amount. Many private payors use Medicare RVUs as the basis of their payment rates.
When CareLink is used to review CGM data, physicians can bill for the interpretation using the CGM data interpretation code, 95251. This code can be billed for data interpretation performed without the patient being present in the office; a face-to-face visit is not required to bill 95251.
| Service | Code and Description | Providers Who Can Perform the Service | Payment Level* |
|---|---|---|---|
| Interpretation of CGM data | 95251 Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report | MD/DO NP/PA |
Medicare RVUs: 1.10 Medicare does not cover Personal CGM, but does publish RVUs for these codes |
CareLink with Insulin Pump Therapy
Diagnosis codes are used by both physicians and hospitals to document the indication for the procedure or service performed.
The list below includes common ICD-9 diagnosis codes for Diabetes Mellitus.*
| ICD-9 | Description | Fifth Digit | |||
|---|---|---|---|---|---|
| 0 | 1 | 2 | 3 | ||
| 250.0 | Diabetes mellitus without mention of complication | type II or unspecified type, not stated as uncontrolled | type I [juvenile type], not stated as uncontrolled | type II or unspecified type, uncontrolled | type I [juvenile type], uncontrolled |
| 250.1 | Diabetes with ketoacidosis | ||||
| 250.4 | Diabetes with renal manifestations | ||||
| 250.5 | Diabetes with ophthalmic manifestations | ||||
| 250.6 | Diabetes with neurological manifestations | ||||
| 250.7 | Diabetes with peripheral circulatory disorders | ||||
| 250.8 | Diabetes with other specified manifestations | ||||
| 250.9 | Diabetes with unspecified complication | ||||
* Excludes 250.2 and 250.3 series for diabetes with coma.
CPT/HCPCS II Codes for Provider Services
Providers use CPT (and certain HCPCS II) codes for all services. Under Medicare’s Resource-Based Relative Value Scale (RBRVS) methodology for physician payment, each code is assigned a point value, the relative value unit (RVU), which is then converted to a dollar payment amount. Many private payors use Medicare RVUs as the basis of their payment rates.
For CareLink used to review data from a patient’s insulin pump (without continuous glucose monitoring data), providers can bill standard evaluation and management (E/M) codes. Some private payors will also allow billing using CPT-4 code 99091. However, 99091 is not covered by Medicare. Not all private payors cover 99091, so it is important to verify coverage with individual payors before billing CPT-4 code 99091.
| Service | Code and Description | Providers Who Can Perform the Service | Payment Level* |
|---|---|---|---|
| Office visit to review insulin pump and/or blood glucose meter data uploaded into CareLink | Evaluation and Management (E/M) Codes: 99211 Office or other outpatient visit (only E/M code that can be performed by a non-physician or mid-level practitioner) 99212-99215 Office or other outpatient visit 99354-99355 Prolonged service, office (must be billed with 99212-99215) |
MD/DO NP/PA |
99211-99215 Medicare: $19-$125 Medicare RVU: 0.52-3.46 99354-99355 Medicare: $92-$91 Medicare RVU: 2.55-2.52 |
| Review of insulin pump and/or blood glucose meter data uploaded into CareLink – no face-to-face visit. | 99091 Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time | MD/DO NP/PA |
Medicare: $54 Medicare RVU: 1.51 Medicare does not cover 99091, but does publish RVUs and rates for this code. |
* Medicare 2009 national average allowable amount, rounded to the nearest full dollar amount. Includes 20% patient copayment amount. All RVUs are for services performed in the physician’s office.
Source: Medicare Physician Fee Schedule 2009.
For questions, e-mail rs.nradvance@medtronic.com with the subject line: Billing & Coding Questions.