Provider Support

Billing Code Information

The information you need to know to understand billing.

^{*Disclaimer: The guidance provided is for reference purposes only. Practitioners should ask properly trained and certified billing personnel to review claims prior to submission to confirm compliance with billing requirements for their specific scenarios.}

Billing CPT Code 99454

Source: AMA CPT Professional Edition 2022

Used to report remote physiologic monitoring services (eg, weight, blood pressure pulse oximetry) during a 30-day period.

• The service must be ordered by a physician or other qualified healthcare professional.
• The device used must be a medical device as defined by the FDA.
• May be used to report supply of the device for daily recording or programmed alert transmissions.
• Not reported if monitoring is less than 16 days.
• Reported only once per patient per 30-day period, even if the patient has multiple devices capable of remote monitoring.
• Auxiliary personnel may provide 99454 services incident to the billing practitioner’s services and under their supervision. Auxiliary personnel may include contracted employees.
• Consent to receive RPM services may be obtained at the time that RPM services are furnished.
• RPM services may be medically necessary for patients with acute conditions as well as patients with chronic conditions.
• Physicians and NPPs who are eligible to furnish E/M services may bill RPM services.

99457 and 99458

Care management services, as well as synchronous, real-time interactions.

This means conversations with patients over the phone, via email, conversations with caretakers, and managing referrals to other providers.

It also entails in-office work, including reviewing and documenting the patient’s chart and plan, refilling prescriptions, ordering and reviewing lab results.