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Coding & Reimbursement Diabetes

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Coding & reimbursement resources

Additional resources

Reimbursement considerations around care management for patients on the InPen™ system (Oct. 2022)

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Frequently asked questions

Coding & billing for continuous glucose monitoring (CGM) services

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Are physicians able to bill for training on Personal CGM devices?

Are there specific ICD-10-CM diagnosis codes that are required to get paid for CGM?

Can a home health agency bill for CGM?

Is CGM reimbursed in an assisted living or skilled nursing facility?

Which types of healthcare providers can perform and bill CPT codes 95249 and 95250?

Which healthcare providers can perform and bill CPT code 95251?

Can an Evaluation and Management (E/M) code be billed on same day as 95249, 95250 or 95251?

How often can CPT codes 95249, 95250 and 95251 be billed for a patient?

Can a pharmacy bill for CPT codes 95250 and 95251?

How do I bill if the sensor did not last 72 hours or if patient did not return to clinic for download?

Should 95250 be billed when a sensor is inserted or when sensor is removed and data is downloaded?

What date should be used to bill 95251?

Does code 95251 require a face-to-face visit?

What is the patient’s out-of-pocket expense for receiving Professional CGM services?

Can a physician and/or hospital be paid for CGM when performed during inpatient stay?

Payer coverage of continuous glucose monitoring (CGM) services

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Does Medicare cover Professional CGM?

Who covers CGM and have they listed CPT codes in their coverage policies?

What are some steps to take if denied for 95250 or 95251?

InPenTM system coding & reimbursement

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Is patient consent needed to report code 99091?

Can I report 99091 on the same date of service as an E/M visit?

What activities count toward the total time required to report treatment management services 99457 and +99458?

Must I have 16 days’ worth of data in the month to report treatment management codes 99457 and +99458?

Can an RD or CDCES perform treatment management services? Can they bill for codes 99457 and +99458?

Coding for services associated with insulin pump therapy

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Are there specific CPT codes for insulin pump starts?

Is there a CPT code for reviewing CareLink data?

Is there a CPT code for reviewing and interpreting pump data?

General reimbursement questions

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Can a cardiologist perform and bill for CGM?

What is the difference between Medicare non-facility and facility fee schedules?

Is there a reference for Medicare fees for a specific locality?


Other code categories are available for less common types of diabetes mellitus including: E08, Diabetes mellitus due to underlying condition; E09, Drug or chemical induced diabetes mellitus; E13, Other specified diabetes mellitus; and O24, Diabetes mellitus in pregnancy, childbirth, and the puerperium (pre-existing and gestational).

The codes shown are examples of specific types of complications within that subcategory. Other codes are available for different complications within the same subcategory. The table is for illustrative purposes only and is not an exhaustive or all-inclusive list of ICD-10-CM diabetes diagnosis codes.


Diabetes characterized as uncontrolled, out-of-control, inadequately controlled, or poorly controlled diabetes is coded to hyperglycemia in ICD-10-CM, unless the lack of control refers to low blood sugar (hypoglycemia).


A seventh digit must be appended to the code to identify which eye is affected.


Medication status is only coded in a secondary position, following the code for diabetes mellitus.


Code Z79.4 can also be assigned to a patient with type 2 diabetes mellitus who routinely uses insulin for control. If a patient is treated with both oral hypoglycemic agents and insulin, only Z79.4 is assigned.


CPT copyright 2021 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.


Centers for Medicare & Medicaid Services. Medicare Program; Revisions to Payment Policies under the Medicare Physician Fee Schedule, Quality Payment Program and Other Revisions to Part B for CY 2022; Published November 19, 2021 with file updates published December 20, 2021. The total RVU as shown here is the sum of three components: physician work RVU, practice expense RVU, and malpractice RVU.


Medicare national average payment is determined by multiplying the sum of the three RVUs by the conversion factor. The conversion factor for CY 2022 is $34.6062.

All Medicare rates displayed in this table reflect the “national unadjusted” amounts inclusive of beneficiary cost-sharing and do not reflect any additional payment adjustments, such as the 2% sequester reduction mandated by the Budget Control Act of 2011 or the 4% PAYGO reduction triggered by the American Rescue Plan in December 2020. Please note that on December 10, 2021, legislation was enacted to delay the 2% sequestration for 3 months (January 1–March 31, 2022), followed by a reduction of 1% for 3 months (April 1–June 30, 2022). The full 2% sequestration cut will go back into effect on July 1, 2022. The 4% PAYGO reduction was postponed through January 1, 2023.


2Centers for Medicare & Medicaid Services. Medicare Program; CY2020 Payment Policies Under the Physician Fee Schedule and Other Changes to Part B Payment Policies Final Rule Correction Notice. Fed. Reg. Vol. 85, No. 1. 62697-62698. Available: 

Humalog® is a registered trademark of Eli Lilly and Company. Fiasp® and Novolog® are registered trademarks of Novo Nordisk A/S.