CPT 95249 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Medicine Services and Procedures • Endocrinology Services |
| Common Place of Service | • 11 - Office • 50 - Federally Qualified Health Center |
| Common Modifiers | • None • 59 - Distinct Procedural Service • PO - Services, procedures and/or surgeries furnished at off-campus provider-based outpatient departments |
| Complexity Level | Low |
National average reimbursement for CPT 95249 by major payers:
$77.69
$71.69
$76.12
$106.62
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 95249 | ||||||
United | 95249 | $70.92 | 1255759627 - CHISOM IWUEKE | 650816256 - (TX) OBSTETRIX MEDICAL GROUP OF TEXAS BILLING INC | SC | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $62.77 | 1184662579 - MID-SOUTH MATERNAL FETAL MEDICINE PC | 20699355 - (TN) MIDSOUTH MATERNAL FETAL MEDICINE PC | TN | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $131.44 | 1023118585 - ALYSSA STEPHENSON-FAMY | 911220843 - ASSOCIATION OF UNIVERSITY PHYSICIANS | WA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $130.13 | 1619980208 - DEBORAH FELDMAN | 60646768 - HOSPITAL OF CENTRAL CONNECTICUT AT NEW BRITAIN GENERAL AND BRADLEY ME | CT | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $61.20 | 1235540154 - SHONTREL COOPER | 381358164 - SPECTRUM HEALTH PRIMARY CARE PARTNERS | MI | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $128.91 | 1144486507 - KAREN ARCHABALD | 931272735 | OR | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $70.92 | 1255759627 - CHISOM IWUEKE | 650592449 - PEDIATRIX MEDICAL GROUP OF GA PC | SC | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $159.46 | 1023118585 - ALYSSA STEPHENSON-FAMY | 910564748 - SEATTLE CHILDRENS HOSPITAL | WA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $64.23 | 1073522827 - KEVIN GOMEZ | 581954432 - (GA) NORTHSIDE HOSPITAL INC | GA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $130.09 | 1477530715 - JAMES BETONI | 330672915 - FACULTY PHYSICIANS AND SURGEONS OF LLUSM | CA | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $157.36 | 1104031822 - ROXANE RAMPERSAD | 822026363 - WASHINGTON UNIVERSITY PHYSICIANS IN ILLINOIS INC | MO | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $84.77 | 1457884553 - WHITNEY KLEINMANN | 481163756 - KANSAS UNIVERSITY PHYSICIANS INC | KS | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $145.21 | 1629337696 - SEVAN VAHANIAN | 135562308 - NEW YORK UNIVERSITY | NY | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $96.16 | 1144587072 - SARAH WHITE | 223849199 - WAKE FOREST UNIVERSITY HEALTH SCIENCES | NC | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 95249 | $173.21 | 1922399641 - CARA DOLIN | 232865181 | OH | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 95249 vs. Other Endocrinology Services Codes
The CPT 95249 code is part of the Medicine Services and Procedures services used for Endocrinology Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 95249 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 95249-CPT | Low | Ambulatory Continuous Glucose Monitoring Of Interstitial Tissue Fluid Via A Subcutaneous Sensor For A Minimum Of 72 Hours; Patient- Provided Equipment Sensor Placement Hook-Up Calibration Of Monitor Patient Training And Printout Of Recording |
| 95250-CPT | Low | Ambulatory Continous Glucose Monitoring Of Intersitial Tissue Fluid Via A Subcutaneous Sensor For A Minimum Of 72 Hours; Physician Or Other Qualified Health Care Professional (Office) Provided Equipment Sensor Placement Hook-Up Calibration Of Monitor Patient Training Removal Of Sensor And Printout Of Recording (Desc Revised 1/1/2018) |
| 95251-CPT | Low | Ambulatory Continuous Glucose Monitoring Of Interstitial Tissue Fluid Via A Subcutaneous Sensor For A Minimum Of 72 Hours; Analysis Interpretation And Report (Desc Revised 1/1/2018) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 95249. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 95249 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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