How much does Medicare pay for CPT 95249?

Medicare allowed an average of $66.48 per service and paid $50.82 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $140.43, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95249?

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin. It was billed 8,915 times to 6,332 Medicare beneficiaries by 282 providers in 2024.

Which specialty bills 95249 most?

Endocrinology, with 5,859 services from 194 clinicians. Next are Internal Medicine, Nurse Practitioner, Family Practice.

CPT 95249

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin

$66.48Medicare-allowed amount per service, averaged across 8,915 services

Providers submitted

$140.43

Asking price, not received

Medicare allowed

$66.48

The fee schedule figure

Medicare paid

$50.82

Balance is patient coinsurance

Providers submitted an average of $140.43 for this code and Medicare allowed $66.48 — 2.1× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $50.82 (76%); the rest is the patient’s coinsurance and deductible.

Services: 8,915
Beneficiaries: 6,332
Providers billing it: 282
Total allowed: $592,669

What Medicare pays for CPT 95249

Across 8,915 services billed by 282 providers to 6,332 beneficiaries, Medicare allowed an average of $66.48 per service. That is 1.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 95249

Specialty	Services	Beneficiaries	Avg allowed	Providers
Endocrinology	5,859	4,296	$67.20	194
Internal Medicine	1,321	800	$67.57	31
Nurse Practitioner	1,252	878	$61.54	38
Family Practice	273	177	$69.15	8
Physician Assistant	113	106	$62.90	7
Hospitalist	32	27	$70.19	1
General Practice	31	15	$70.25	1
Geriatric Medicine	20	19	$75.28	1
Cardiology	14	14	$52.92	1

95249 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	1,778	$72.62	$48.56	33
New York	1,174	$76.88	$49.69	32
Illinois	1,021	$65.88	$48.94	20
Florida	809	$61.34	$48.87	22
Texas	626	$61.36	$47.89	30
Maryland	465	$68.03	$45.38	13
New Jersey	325	$71.36	$49.19	9
Pennsylvania	242	$61.29	$48.09	12
Mississippi	227	$51.81	$42.87	5
Alabama	202	$53.62	$46.67	4
Louisiana	178	$54.03	$44.21	6
Massachusetts	157	$70.16	$45.35	6
Georgia	156	$62.17	$48.54	9
North Carolina	122	$59.70	$45.43	7
Tennessee	112	$56.38	$47.09	6
Arizona	112	$59.42	$47.67	5
South Carolina	103	$60.14	$45.82	6
Delaware	91	$63.62	$47.12	4
Virginia	76	$66.39	$45.12	4
Wisconsin	73	$61.01	$46.04	4
Indiana	73	$58.57	$44.35	5
Connecticut	73	$71.73	$48.87	3
Missouri	66	$55.78	$48.38	2
Minnesota	64	$63.99	$48.87	4
Michigan	62	$64.09	$47.20	4
Kentucky	54	$56.98	$45.61	3
Washington	50	$65.16	$45.36	3
New Hampshire	49	$61.66	$43.48	1
Iowa	47	$57.93	$47.10	2
Utah	40	$58.57	$45.11	2
Ohio	39	$58.58	$51.09	1
Wyoming	29	$63.86	$47.65	1
Montana	28	$64.62	$47.51	2
Colorado	28	$67.40	$44.83	1
Oregon	25	$62.77	$39.92	1
Kansas	24	$57.59	$42.83	2
West Virginia	19	$55.96	$51.16	1
District of Columbia	17	$77.04	$47.99	1
Oklahoma	16	$56.93	$50.99	1
Guam	13	$73.85	$47.02	1
Arkansas	13	$54.69	$43.43	1
Vermont	13	$63.04	$51.09	1
New Mexico	12	$60.15	$51.08	1
Nevada	12	$61.07	$46.77	1

Related codes

95251Continuous monitoring of blood sugar level in tissue fluid$32.37
95250Continuous monitoring of blood sugar level in tissue fluid$152.88

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.