Continuous glucose monitors (CGMs) are rapidly becoming a cornerstone of diabetes management. In fact, the 2025 ADA Standards of Care in Diabetes recommend expanding CGM access for more patients than ever before.
However, many endocrinology practices still struggle to fully leverage the continuous data stream from CGMs to deliver proactive, high-quality care. This challenge is largely due to the complexities of remote monitoring for CGMs, which require automated access to CGM and insulin pump data, and a deep understanding of the tools and workflows needed for success.
Billing, in particular, can be a significant hurdle in setting up a program that supports year-round monitoring of CGMs. Yet, understanding the relevant CPT codes is crucial to ensuring proper reimbursement for the work involved.
In this article, we'll break down the essential CPT codes for remote CGM monitoring.
SweetSpot is offering a free webinar where we will walk through best practices for remote CGM monitoring, covering topics such as billing and patient cost. You can register here to attend live or receive the recording.
Key CPT Codes for Remote CGM Monitoring
CPT 95251: CGM Data Review
CPT code 95251 covers the analysis, interpretation, and reporting of at least 72 hours of CGM data.
CPT code 95251 can be billed every 30 days for either in-person or remote CGM data reviews.
The Date of Service (DOS) on documentation should be the date the review is completed.
The average Medicare allowance is ~$34 (but can vary)
SweetSpot automatically flags when a patient is eligible for a data review billable under code 95251, ensuring accuracy and compliance, and our auto-text documentation streamlines charting for an improved workflow.
Plus, our clinical team of CDCESs facilitate these reviews for practices using SweetSpot each month, enabling our partners to provide better, more proactive patient care without straining their staff and increasing the number of billable events per month.
CPT 99454: Data Collection & Transmission
CPT code 99454 covers the automated collection of physiologic data, including glucose data collected through SweetSpot.
CPT code 99454 requires at least 16 days of data per 30-day billing cycle.
The DOS on documentation is typically the last day of the month.
The average Medicare allowance is ~$47 (but can vary depending on region)
SweetSpot automatically tracks patient data daily to monitor when the 16-day threshold is met. At the end of each month, SweetSpot provides the practice with a claims-ready billing report, clearly identifying which patients have met the required data thresholds for billing.
CPT 99457: First 20 Minutes of Remote Monitoring Management
CPT code 99457 covers the time spent by clinical staff reviewing patient data, making regimen adjustments, and providing interactive communication.
CPT code 99457 requires at least 20 minutes of patient management per month and requires at least one phone call with the patient.
The DOS is the last calendar day of the month (as the time spent is cumulative).
The average Medicare allowance is ~$48 (but can vary depending on region).
SweetSpot automatically tracks and logs time spent on patient care, cumulatively, across all team members, making it easy to document and bill for 99457 services.
CPT 99458: Additional Time for Remote Monitoring Management
CPT code 99458 covers each additional 20 minutes of remote patient monitoring beyond the initial 20-minutes facilitated through 99457.
The DOS is the last calendar day of the month (as the time spent is cumulative).
The average Medicare allowance is ~$39 (but can vary depending on region)
SweetSpot automatically tracks and logs time spent on patient care, cumulatively, across all team members, making it easy to document and bill for 99458 services.
Best Practices for Reimbursement Documentation for Remote CGM Monitoring
Accurate and comprehensive documentation is essential for maintaining compliance with billing requirements and optimizing reimbursement. SweetSpot automatically generates and supports the necessary documentation to support all applicable CPT codes. Below are the key elements to document to ensure successful reimbursement
1. Patient Consent
Before initiating remote patient monitoring, it is essential to document the patient’s informed consent. Properly recording this information ensures compliance with regulatory requirements and protects both the provider and the patient in the billing process.
Consent documentation should include:
The date consent was obtained
Method of consent (verbal, written, or electronic)
Confirmation that the patient consents to and understands the following:
What the program is (remote patient monitoring for diabetes)
How the program works (frequency of data reviews and communication)
Why the program is being offered to them (they have a chronic disease)
Any financial responsibility they may have
Right to opt-out of the program and how to do so
That only one provider that they see can bill for RPM at any time
📌 Example documentation:
"Patient provided verbal consent on [date] for remote patient monitoring. They understand that this service is offered due to their chronic condition (diabetes) and that their care team will proactively monitor their diabetes on a monthly basis. The patient acknowledges that there may be costs associated with this service, depending on their insurance plan. They also understand that they can withdraw consent at any time by contacting their care team and confirm that they are not receiving remote patient monitoring from any other provider.”
Consenting patients for a new remote patient monitoring program is no small feat. SweetSpot’s Patient Engagement Team handles consent documentation for our practice partners, ensuring compliance, clarity, and program growth.
2. Data Review (CPT 95251)
Ensure that CGM reports are uploaded to the patient’s chart, with key findings, adjustments, and recommendations clearly documented. SweetSpot’s auto-text notes streamline documentation, making charting fast and accurate. Additionally, our clinical team ensures that all relevant CGM and insulin pump reports are properly documented in the patient’s chart within your EHR.
3. Data Collection (CPT 99454)
To meet the billing requirements for CPT 99454, confirm that at least 16 days of CGM data were collected during the billing period. It is important to note that the 16 days of data must be collected distinctly and separately from the data automatically collected by the CGM itself.
The data being billed for is collected through SweetSpot, ensuring compliance with CPT 99454 billing standards and enabling practices to bill for this code. SweetSpot automatically logs data collection and generates detailed, claims-ready reports that can be easily incorporated into the patient’s chart for accurate and efficient documentation.
4. Time Tracking (CPT 99457/99458)
Record all time spent reviewing data, communicating with patients, and adjusting treatment plans to ensure accurate documentation and reimbursement.
SweetSpot simplifies this process by providing a downloadable log that tracks time spent on patient management, ensuring easy compliance and streamlined billing. Additionally, SweetSpot’s auto-text notes not only streamline documentation but also include the current time spent within the calendar month, making it readily available in every note.
Patient Cost & Coverage for Remote CGM Monitoring
Understanding insurance coverage is vital, and even with upfront discussions, unexpected financial burdens can still arise for patients. At SweetSpot, we believe that clear communication is the foundation for managing expectations and fostering trust with patients. That’s why we prioritize discussing potential costs during the consent process.
To address this, SweetSpot’s Patient Engagement Team ensures patients have a clear picture of what to expect as well as a clear line of communication if any questions arise. We guide patients through their insurance coverage and potential costs, leveraging our experience with various plans to provide clarity. Patients are also informed that they can opt out if costs become prohibitive and given a direct line of contact if they wish to do so or for any other questions that they may have.
Here’s what our experience shows:
65% of patients (Medicare and many commercial plans) have full coverage.
35% of patients experience cost-sharing, depending on their insurance.
Coinsurance typically ranges from $6–$15 per month.
Copays average around $35 per month
These numbers can be more or less depending on a patient’s specific plan
Denials are rare, and when they do occur, they are typically resolved in the patient’s favor.
By proactively addressing costs and maintaining open communication, we help patients make informed decisions and feel confident about participating in SweetSpot's remote monitoring program.
Navigating remote CGM billing can be complex, and the landscape is constantly evolving. For example, starting in 2026, there will be an additional CPT code that covers 2-15 days of collected and transmitted data, as well as shorter time requirements for patient interaction for billing 99457 and 99458.
That’s why it’s not just important to have the right workflow and tools, but also to have the right partner—one with a pulse on the market and these ongoing changes. As CGMs become more integrated into diabetes management, the rules are evolving with them. SweetSpot is here to guide you through remote CGM monitoring billing and implementation, setting you up for success in 2025 and beyond.
Join us for a free webinar where we will walk through best practices for remote CGM monitoring, covering topics such as billing and patient cost, to help you stay ahead in diabetes management. You can register here to attend live or receive the recording.
SweetSpot is a remote diabetes management platform that supports all major diabetes devices and insulin delivery systems to provide physicians with a single view of their patients’ data. SweetSpot's intelligent algorithm identifies the most optimal CPT codes for both remote and in-person diabetes management, and a dedicated team of Certified Diabetes Care & Education Specialists provide ongoing support.
As a company founded and powered by physicians and diabetes care providers, we place a strong emphasis on ensuring that there are no obstacles to getting started with SweetSpot. That’s why SweetSpot is easy to set up and designed to seamlessly integrate into your existing workflows and comes with no setup costs or subscription fees.