Type 2 diabetes
Continuous glucose data made the signal free. The scarce thing is the person who acts on it.
What gets measured, from where, and why it earns its place
Every source is tagged at ingest as billable or context-only. Context-only data is clinically valuable and never enters a device-supply line.
Thresholds, and who has to do something about them
Red marks a same-day or immediate pathway. Amber marks a review within the stated window. Each one is assigned to a named clinician with a response clock, not to a queue.
What we will not oversell
If your patient is on an incretin for weight rather than glycemia, the program design changes and so does the track. See the obesity and incretin therapy page.
How the month actually runs
What this program can bill
Rates are national non-facility averages, rounded, for orientation. They vary by locality and payer. Verify against your fee schedule before you model revenue on them.
| Code | What it covers | National avg | Cadence |
|---|---|---|---|
| 99453 | Setup and patient education One-time device setup and patient education per episode of care. | $22 | once per episode |
| 99454 | Device supply, 16-30 days Device supply with daily recordings or programmed alerts, 16 or more days of data in 30. | $52 | per 30 days |
| 99445new 2026 | Device supply, 2-15 days New for 2026. Device supply where 2 to 15 days of data were transmitted in 30. Paid at the same rate as 99454. Mutually exclusive with 99454. | $52 | per 30 days |
| 99457 | Treatment management, first 20 min Clinical staff or QHP time, 20 minutes, with at least one interactive communication. | $52 | per calendar month |
| 99458 | Treatment management, each additional 20 min Add-on to 99457. Reported per additional 20 minutes in the month. | $41 | per additional 20 min |
| 99091 | Data collection and interpretation, 30 min QHP collection and interpretation of physiologic data. Cannot be stacked with 99457/99458 for the same service period. | $58 | per 30 days |
Diagnosis anchors
| ICD-10-CM | Description |
|---|---|
| E11.9 | Type 2 diabetes mellitus without complications |
| E11.65 | Type 2 diabetes mellitus with hyperglycemia |
| E11.22 | Type 2 diabetes mellitus with diabetic chronic kidney disease |
Illustrative anchors only. Code to the documented clinical picture, not to a list on a vendor website.
The rules that break programs
One billing clinician per 30-day episode. RPM and RTM are not additive in the same calendar month. Duration codes are mutually exclusive. Management time requires at least one real-time interactive communication. Medical necessity precedes enrollment.
If you are a manufacturer looking at this condition
Read this before you fund anything
Sponsor-funded monitoring that produces billable revenue for prescribers is remuneration to referral sources under the federal Anti-Kickback Statute. The structures that survive scrutiny keep the sponsor's data interest and the provider's billing interest completely separate. The three structures we will build, and the one we will not.
Type 2 diabetes monitoring, answered directly
Is CGM data enough on its own to bill RPM?
Can we run one program for diabetes and hypertension together?
Conditions that travel with this one
Comorbidity is the norm. One episode, one billing clinician, one device-supply line per 30 days, even when the patient has four diagnoses.