[Short Video] How to Optimize Remote CGM Monitoring & Reimbursement

Remote CGM monitoring has the power to transform diabetes management at your practice, enabling proactive interventions between appointments and improving patient outcomes. However, setting up a successful program comes with challenges, from data fragmentation to navigating reimbursement complexities. 

In our recent webinar, we explored the key hurdles to implementing remote CGM monitoring, best practices for building a strong and effective program, and the financial considerations that ensure long-term sustainability.   Watch the highlights from our webinar below or find the full recording here.

Overcoming Barriers to Remote CGM Monitoring  

Many clinics recognize the value of remote CGM monitoring but struggle with execution. The biggest challenges include: 

• Data Fragmentation: CGM data is often dispersed across multiple device manufacturers’ platforms, making it difficult to compile a comprehensive view of patient trends. A centralized platform that integrates data across devices is crucial for effective monitoring. 

• Staff and Resource Limitations: Providers and clinic staff are busy with in-person visits, making it hard to dedicate time for ongoing remote monitoring and proactive outreach. Without a structured workflow, patient data can go unreviewed for months. 

• Billing and Reimbursement Complexities: Understanding which CPT codes apply to remote CGM monitoring—and ensuring accurate documentation—is a major challenge for many practices.  2. Does the data collected from a CGM need to be from office-provided devices to use certain billing codes? 

What an Effective Remote CGM Monitoring Workflow Looks Like  

With the right tools, clinics can streamline CGM data review and ensure timely interventions. A well-structured remote monitoring program includes: 

✔️ A Centralized CGM Dashboard – Aggregating CGM data in one place makes it easier to flag patients who need a treatment adjustment. Prioritizing high-risk patients ensures that clinical efforts are focused where they’re needed most. 

✔️ Regular Data Reviews – With a strong workflow in place, CGM data reviews can occur every 30 days, with additional touchpoints triggered by significant changes in glucose trends. This ensures that adjustments happen in real-time rather than waiting for the next scheduled visit. 

✔️ Proactive Interventions – Without remote CGM data reviews, patients can go months between visits without any data-driven adjustments. Now, providers can intervene when glucose patterns shift, preventing complications and improving long-term outcomes. 

Breaking Down the CPT Codes for Remote CGM Monitoring 

Understanding billing is essential for making remote monitoring financially viable. Here’s how practices can leverage key CPT codes: 

95251 – CGM Data Review: Covers the analysis, interpretation, and reporting of at least 72 hours of CGM data. Many practices bill this during in-person visits but overlook its use between visits. 

99457 & 99458 – Covers the time spent by clinical staff, physician, or other QHCP on treatment management services. 99457 accounts for the first 20 minutes of care management, while 99458 covers additional time. These codes ensure that all patient engagement and decision-making efforts are reimbursed. 

99454 – Data Collection & Transmission: Covers the collection and processing of physiologic data. With platforms like SweetSpot, clinics can bill for remote CGM data collection and triage, making remote monitoring a sustainable part of care. 

By tapping into these codes, practices can ensure their remote CGM programs are both clinically impactful and financially viable. 

What We've Seen for Patient Costs Nationwide  

Patient affordability is a key concern, but most patients experience minimal out-of-pocket costs for remote CGM monitoring. Based on our experience across the country: 

•  65% of patients are fully covered for remote CGM monitoring, particularly those with Medicare and secondary insurance. 

• 35% of patients have some level of cost-sharing, such as copays or coinsurance, which vary by plan. 
  

By addressing cost considerations upfront and helping patients understand their coverage, practices can improve enrollment and engagement in remote monitoring programs. 

Take the Next Step in Remote CGM Monitoring 

Implementing remote CGM monitoring doesn’t have to be overwhelming. With the right platform and a structured approach, practices can overcome barriers, optimize billing, and ensure that patients receive proactive, data-driven care. 

Want to dive deeper into these insights? Watch the full webinar here.  

If you’d like to discuss how we can support your clinic in leveraging data from CGMs and insulin pumps to enhance patient outcomes, reach out to us at info@sweetspot.health.  

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SweetSpot partners with endocrinology practices to provide virtual CGM monitoring and enhanced patient care.

SweetSpot combines a centralized software platform for managing diabetes device data, such as data from CGMs and insulin pumps, with wrap-around clinical support services. SweetSpot’s virtual team of Certified Diabetes Care and Education Specialists (CDCES) perform monthly CGM data reviews and coordinate with providers and patients to facilitate treatment plan changes. By actively managing and remotely reviewing CGM data between patient visits, we ensure patients receive timely treatment adjustments to improve glycemic control and patient outcomes.

Additionally, SweetSpot’s automated capture of reimbursable care events optimizes CPT code utilization, unlocking new revenue streams for practices and making our partnerships both clinically effective and financially profitable.