CPT 95251
Global XXX ActiveCont gluc mntr analysis i&r
CPT 95251 Billing & Documentation Guide
CPT code 95251 (Cont gluc mntr analysis i&r) is classified under Medicine/E&M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.68, a non-facility practice expense RVU of 0.32, and a malpractice RVU of 0.05, a total non-facility RVU of 1.05 and facility RVU of 1.05. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $35.76, though rates vary from $32.75 to $46.37 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 95251, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 95251 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 95251 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 95251
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.68 | 0.68 |
| Practice Expense RVU | 0.32 | 0.32 |
| Malpractice RVU | 0.05 | 0.05 |
| Total RVU | 1.05 | 1.05 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 95251
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $37.08 | $37.08 | $35.71 - $41.52 | 29 |
| Florida | $36.69 | $36.69 | $35.44 - $38.06 | 3 |
| Georgia | $34.95 | $34.95 | $34.24 - $35.65 | 2 |
| Illinois | $36.31 | $36.31 | $35.08 - $37.45 | 4 |
| Michigan | $35.1 | $35.1 | $34.36 - $35.84 | 2 |
| North Carolina | $33.75 | $33.75 | $33.75 - $33.75 | 1 |
| New York | $37.98 | $37.98 | $34.04 - $39.98 | 5 |
| Ohio | $34.15 | $34.15 | $34.15 - $34.15 | 1 |
| Pennsylvania | $35.17 | $35.17 | $34.1 - $36.24 | 2 |
| Texas | $34.91 | $34.91 | $33.99 - $35.81 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 95251
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 95251 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0733T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 82945 | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 82947 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 82948 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 82950 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 82951 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 82952 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 82953 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 95251
What does CPT code 95251 mean? +
CPT code 95251 represents: Cont gluc mntr analysis i&r. It's in the Medicine/E&M category with a global period of XXX.
What is the Medicare reimbursement for CPT 95251? +
The 2026 Medicare national average non-facility payment for CPT 95251 is $35.76. Rates range from $32.75 to $46.37 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 95251? +
Medicine section spans a wide range: therapy services use GP/GO/GN (PT/OT/SLP plans of care) and KX (above cap with documentation). Drug administration uses JW (waste) and JZ (no waste). Professional/technical split applies to some diagnostic codes.
What bundling edits apply to CPT 95251? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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