{
    "code": "95251",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/95251/2019/A",
    "release_specific_url": "https://localishealth.com/cpt/95251/2019/C",
    "description": "The clinician's review of data downloaded from a continuous glucose sensor worn under the skin, which samples glucose around the clock rather than at finger-stick moments. The clinician reads the trend graphs and overnight patterns, works out where the highs and lows cluster, writes an interpretation, and adjusts treatment accordingly. At least three days of recorded data are needed for the review to be meaningful. This is the interpretation and report; putting the sensor on, calibrating it and training the patient are recorded under a separate code.",
    "answer": {
        "question": "How much did Medicare pay for CPT 95251 in Q3 2019?",
        "text": "Medicare paid $36.40 for CPT 95251 in the office (non-facility) setting and $36.40 in a facility under the Q3 2019 Physician Fee Schedule, effective July 2019. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2019, when it decreased 0.9%."
    },
    "release": {
        "schedule": "pfs",
        "year": 2019,
        "quarter": "C",
        "label": "Q3 2019",
        "effective": "July 1 – September 30, 2019",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 36.4,
        "facility": 36.4,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 0.7,
        "practice_expense_non_facility": 0.27,
        "practice_expense_facility": 0.27,
        "malpractice": 0.04
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 36.0391,
    "source": {
        "label": "Physician relative value file (Q3 2019)",
        "cms_url": "https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu19c.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2019/C",
        "file": "PPRRVU19_JUL.csv",
        "row": 16360,
        "sha256": "2ea00e3e75fc3a53497bb8eb3c7d29a58404efd9449993daa6f80791a770b47a"
    },
    "modified_at": "2026-08-04T03:09:02+00:00"
}