Learn what devices are used and who qualifies for CPT Code 99458.
CPT Code 99458 is a remote monitoring billing code used to reimburse practices for remote care services through Medicare. Code 99458 varies slightly from other codes as it is considered an add-on to CPT Code 99457, rather than being considered a standalone code.
Frequently Asked Questions
To qualify for reimbursement for Code 99458, physicians must first meet the 20 minutes of service requirement for Code 99457, then bill for each following additional 20 minutes of service. This code helps to provide for practices who support remote patients with extra care and additional services by allowing practices to bill for services provided beyond the required 20 minutes.
RPM companies such as 100Plus make interactive remote patient care necessary for Medicare reimbursement easy and accessible.
Similar to CPT Code 99457, Code 99458 requires interactive communication in order to be added on to reimbursements. This interactive communication is defined as “ a conversation occurring in real time that includes synchronous, two-way interactions that can be enhanced with video or other kinds of data.” Additionally, the CMS clarified that the 20 minutes of service time required to bill for both 99457 and 99458 “should include care management services and synchronous, real-time interactions.” Therefore making it clear that, while interactive communication contributes to the required 20 minutes, it is not the only activity that should be included in the total time as overall care management can contribute as well.
All Medicare patients with chronic conditions such as diabetes, obesity, CHF, and hypertension qualify for CPT Code 99458. 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 99458, in order to effectively cover Medicare patients in need of remote care.
The major devices used for code 99458 are:
- Blood Pressure Cuff
- Pulse Oximeter
- Blood Glucose Monitor
- Digital Weight Scale
Since CPT Code 99458 is only an add-on code for CPT Code 99457, it can’t cover the cost of the device on its own. Patients that qualify for the original CPT Code 99457, however, are covered by said code for treatment services and device cost.
Medicare reimburses approximately $42.00 for CPT Code 99458. This CPT code in particular is for additional time spent with a patient and can be billed only after practices meet the requirements for CPT Code 99457.
In order to get reimbursed for CPT Code 99458, clinical staff or other qualified health care professionals must use the results collected by remote monitoring services in order to deliver a personal treatment plan. To get reimbursed for Code 99458, clinicians must first complete the requirements and submit for reimbursement under CPT Code 99457, as Code 99458 is only an add-on to Code 99457. All reimbursement codes are submitted directly to Medicare and can be billed in increments of 20 minutes. These services can be supplied by qualified healthcare providers if they are under the general supervision of the primary physician.
Under Code 99458, incidental to Code 99457, RPM services can be delivered by any qualified healthcare professional if the services are completed under the general supervision of the primary physician. Therefore, it is not the direct physician who is entirely responsible for providing services or submitting reimbursement claims, as the work can also be performed by other qualified employees within a practice.
CPT Code 99548 does not currently have any limitations regarding the frequency with which it can be billed per month. Providers can bill under CPT Code 99458 for each additional 20 minutes of services provided if those 20 minutes meet the requirements for reimbursement.
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