How much does Medicare pay for CPT 95251?

Medicare allowed an average of $32.37 per service and paid $24.57 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $107.14, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 95251?

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report. It was billed 802,216 times to 395,924 Medicare beneficiaries by 6,772 providers in 2024.

Does 95251 pay differently in an office than a hospital?

Yes. The allowed amount averaged $32.47 in an office setting and $31.44 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 95251 most?

Endocrinology, with 491,306 services from 3,858 clinicians. Next are Nurse Practitioner, Internal Medicine, Physician Assistant.

CPT 95251

Continuous monitoring of blood sugar level in tissue fluid using sensor under skin with interpretation and report

$32.37Medicare-allowed amount per service, averaged across 802,216 services

Providers submitted

$107.14

Asking price, not received

Medicare allowed

$32.37

The fee schedule figure

Medicare paid

$24.57

Balance is patient coinsurance

Providers submitted an average of $107.14 for this code and Medicare allowed $32.37 — 3.3× 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 $24.57 (76%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $32.47
Hospital / facility: $31.44

The office rate is higher because the practice supplies the room, staff and equipment out of that payment. In a hospital the facility bills those separately, so the clinician's share is smaller — the total cost to Medicare is usually higher, not lower. 723,124 services were billed in an office setting and 79,092 in a facility.

Services: 802,216
Beneficiaries: 395,924
Providers billing it: 6,772
Total allowed: $25,967,732

What Medicare pays for CPT 95251

Across 802,216 services billed by 6,772 providers to 395,924 beneficiaries, Medicare allowed an average of $32.37 per service. That is 2.0 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 95251

Specialty	Services	Beneficiaries	Avg allowed	Providers
Endocrinology	491,306	239,178	$34.08	3,858
Nurse Practitioner	182,723	94,407	$28.31	1,542
Internal Medicine	60,832	27,738	$34.01	643
Physician Assistant	52,441	28,050	$28.45	513
Family Practice	7,865	3,812	$33.17	153
Certified Clinical Nurse Specialist	2,181	1,157	$28.44	19
General Practice	1,896	388	$35.83	12
Thoracic Surgery	577	85	$31.18	1
Hospitalist	557	275	$34.41	7
Geriatric Medicine	366	152	$35.23	2
Cardiology	291	79	$32.48	2
Nephrology	222	121	$34.30	6
Gastroenterology	205	110	$33.81	1
Infectious Disease	195	97	$35.20	2
Emergency Medicine	130	62	$36.11	3

95251 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	61,004	$35.10	$25.07	501
Florida	58,798	$33.12	$24.79	401
Texas	58,028	$32.70	$25.03	450
New York	49,348	$35.64	$24.95	495
Illinois	36,789	$33.18	$24.57	289
Pennsylvania	35,087	$31.99	$24.40	331
New Jersey	34,043	$35.69	$25.52	301
Ohio	28,557	$30.65	$23.85	276
North Carolina	25,701	$30.93	$24.32	226
Georgia	24,978	$32.20	$24.67	208
Maryland	24,154	$34.09	$25.08	168
Virginia	24,040	$32.16	$24.34	187
Massachusetts	23,466	$33.18	$24.17	238
Indiana	21,273	$30.29	$24.03	163
Missouri	20,442	$31.36	$24.43	161
Michigan	19,383	$32.33	$24.60	215
Tennessee	19,164	$29.26	$23.49	150
Arizona	17,733	$31.84	$24.60	119
South Carolina	15,828	$31.21	$24.48	106
Washington	15,047	$32.14	$23.81	143
Kansas	12,273	$29.26	$23.21	76
Kentucky	11,794	$29.96	$23.34	109
Wisconsin	11,681	$30.05	$23.64	143
Oklahoma	10,624	$30.19	$23.89	88
Louisiana	10,374	$29.52	$23.67	83
Alabama	10,181	$30.56	$24.95	72
Mississippi	10,137	$29.42	$23.55	54
Colorado	10,107	$32.23	$24.24	85
Minnesota	9,718	$30.69	$23.85	114
Connecticut	9,566	$34.12	$24.30	136
Arkansas	9,404	$30.30	$24.50	47
Iowa	8,592	$29.38	$23.58	54
Nebraska	7,341	$29.71	$23.43	54
New Hampshire	6,619	$31.42	$23.55	60
Utah	5,799	$29.87	$23.25	44
Oregon	5,722	$31.53	$24.02	67
Nevada	5,285	$31.69	$25.47	41
Montana	4,576	$30.44	$22.98	29
Delaware	4,398	$32.84	$24.95	25
West Virginia	4,127	$30.36	$23.41	43
South Dakota	3,658	$29.94	$23.14	26
Idaho	3,580	$29.27	$22.97	36
New Mexico	2,627	$31.01	$23.84	26
Maine	2,227	$29.53	$22.94	30
North Dakota	1,693	$29.20	$22.15	12
Rhode Island	1,575	$32.63	$24.26	19
Vermont	1,550	$30.65	$23.42	13
Alaska	1,385	$39.47	$22.23	15
District of Columbia	1,171	$35.41	$25.22	17
Hawaii	958	$32.40	$24.92	13
Puerto Rico	201	$35.67	$24.75	6
Wyoming	199	$30.90	$23.95	3
Guam	110	$35.09	$25.37	1
AP	41	$28.89	$19.82	1
XX	31	$33.27	$25.18	1
U.S. Virgin Islands	29	$33.77	$22.55	1

Related codes

95250Continuous monitoring of blood sugar level in tissue fluid$152.88
95249Continuous monitoring of blood sugar level in tissue fluid$66.48

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.