Information last updated March 17, 2025
Medicare reimbursement for Remote Patient Monitoring (RPM) can make it financially viable for a practice to adopt this technology and complement to care.
RPM codes are Evaluation and Management (E/M) services. CPT codes 99457 and 99458 can only be furnished by a physician or other qualified health care professional, or by clinical staff under the general supervision of the physician (eligible to bill Medicare for E/M services).
- Allowed for patients with both chronic and acute conditions
- Must be for an established patient
- Monitoring must occur over at least 16 days of a 30-day period for CPT codes 99453 and 99454 to be billed.
- When multiple medical devices are provided to a patient, the services associated with all the medical devices can be billed only once per patient per 30-day period and only when at least 16 days of data have been collected.
- CPT 99453 can be billed only once per episode of care, beginning when the RPM service is initiated and ends with attainment of targeted treatment goals.
CPT Codes:
| Code | Description |
|---|---|
| 99453 | Initial patient set up and education on use of equipment, can be done remotely by practice staff. (Bill only once per patient per episode of care, per provider, per 30-days, and only when at least 16 days of data have been collected on at least one medical device. For CGM, use codes 95250, 95249, and 95251.) |
| 99454 | Delivery of results/reports by practice staff to the physician caring for the patient; can be billed once every 30 days. (Bill only once per patient, per provider, per 30-days, and only when at least 16 days of data have been collected on at least one medical device. For CGM, use codes 95250, 95249, and 95251.) |
| 99457 | First 20 minutes of physician’s interpretation and interactive communication with the patient/care giver every month. “Interactive communication” involves, at a minimum, a real-time synchronous, two-way audio interaction that is capable of being enhanced with video or other kinds of data transmission. (The 20 minutes includes both synchronous, real-time interactions as well as non-face-to-face care management services.) |
| 99458 | Subsequent 20 minutes of physician’s interpretation and interactive communication with the patient/caregiver every month. (The 20 minutes includes both synchronous, real-time interactions as well as non-face-to-face care management services.) |
| 99473 | Specific to self-measured blood pressure monitoring (SMBP), use this code for patient education/training and device calibration. This code can only be submitted once per device. 99473 should not be reported if performed as part of an E/M service. |
| 99474 | Specific to SMBP monitoring, submit this code once a month for ongoing treatment decisions based on the average of the patient’s SMBP readings. This code can be used when patients and/or caregivers report their BP readings back to the practice—whether it is done electronically or in person with a SMBP recording log—which then allow the physician to make ongoing treatment decisions. If 99474 services are provided on the same day the patient presents for an evaluation and management (E/M) service to the same provider, these services should be considered part of the E/M service and not reported separately. |
| 99091 | Collection and interpretation of physiologic data (eg, ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, requiring a minimum of 30 minutes of time, each 30 days. This code does not require interactive communication like 99457 to bill. However, it requires a physician or other QHP to perform these services, and requires 30 minutes of time every 30 days (not every calendar month) to bill. This code cannot be reported it if occurs within 30 days of codes 99339, 99340, 99374-9 or 99457. |
| 95249 | 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 (once during the time period that the patient owns the device) |
| 95250 | Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal of sensor, and printout of recording (once per month per patient). |
| 95251 | Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; interpretation and report (once per month per patient). |