CPT Code 99457 - Remote Patient Monitoring Guide

CPT Code 99457 - Remote Patient Monitoring Guide

CPT Code 99457 is a monthly billing code for Remote Patient Monitoring which reimburses providers for the direct expenses of remotely monitoring physiologic data while treating a patient. In order to qualify for reimbursement, clinicians or other healthcare professionals must provide at least 20 minutes of interactive patient care per calendar month. 100Plus facilitates interactive remote care with its patient clinician portal, making remote patient monitoring easy and accessible by bridging the gap between visits with consistent patient data.

What services are required for CPT Code 99457?

In order to bill for and be reimbursed for CPT Code 99457, physicians, NP, or clinical staff must provide “interactive communication” services. This communication is a conversation between the patient and physician, NP, or clinical staff such as email or other instant messaging platform, and includes a synchronous, two-way interaction between the two parties. Patient data, collected and reviewed by the provider, can and should be used to enhance these interactive communications in order to make informed decisions regarding the patient's treatment. In order to reach the requirements for monthly billing under CPT Code 99457, this interactive communication must occur for at least 20 minutes, which can also include time spent on furnishing care management services. 

Who qualifies for CPT Code 99457?

All remote patients covered by Medicare suffering from chronic illnesses qualify for CPT Code 99457. The expansion of the remote patient population that came with COVID-19 pandemic, allowed even more Medicare patients to qualify for these CPT codes. In response to the public health crisis, the CMS finalized a series of CPT codes, including Code 99457, in order to effectively cover Medicare patients in need of remote care. 

What devices are used for CPT Code 99457? 

Major devices used for CPT code 99457 are:

Does CPT Code 99457 cover the device cost?

CPT Code 99457 covers remote monitoring and treatment services of the patient. 

How much does Medicare reimburse for 99457?

On average, Medicare reimburses $61.00 for CPT Code 99457 only once per calendar month, regardless of any given patient's condition.

How to get reimbursed for Remote Patient Monitoring with CPT Code 99457?

To get reimbursed for Remote Patient Monitoring with CPT Code 99457, the primary physician must enroll a patient into the program and provide interactive care. This interactive care can consist of text, email, phone, or other electronic communication. The main service required by this code includes the reviewing and interpretation of patient data and consequential treatment and management of patients using said data. As long as a physician meets these qualifications, they can submit reimbursement claims to Medicare via CPT Code 99457.

Do Remote Patient Monitoring devices have to be FDA certified for CPT 99457?

The Centers for Medicare and Medicaid Services (CMS) has not stated the specific types of technology or devices that apply to this particular CPT Code in the most recent CMS-1693-F final rule. The CMS has stated that the device must be a “medical device as defined by the FDA.” Medicare does not require the device to be “approved” or “cleared” by the FDA, but specific providers may require FDA approval for RPM devices.

Who must complete the time for each remote patient monitoring service?

In the past, CPT Code 99457 has applied only to medical professionals with regards to spending time with their patients. The code therefore could not “be furnished by auxiliary personnel incident to a practitioner’s professional services.” This has since changed, however, and practitioners are now allowed to perform RPM services under the supervision of the primary MD. Ultimately it is the primary healthcare provider or physician that must do the work, or supervise the work, for each remote patient monitoring service.

How often can CPT Code 99457 be billed?

CPT Code 99457 must be billed by a qualified healthcare provider or clinical staff who acts in accordance with the applicable state and practice guidelines. This code requires the provider to spend at least 20 minutes per calendar month providing services to their patient.

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