What is a CPT code?
The Current Procedural Terminology (CPT®) codes offer doctors and other medical professionals a uniform language for coding and referring to common medical services, procedures and tasks.
CPT codes help to streamline administrative duties and help create efficiency and accuracy in billing and claims processing.
For more details on CPT codes, refer to the official government’s website for more details.
Here are common CPT codes relevant in remote patient care and/or monitoring:
CPT Code 99453
Billing Frequency Once At Setup | $18.80
Initial set-up and patient education on the use of equipment
Using CPT Code 99453, physicians will be reimbursed for initiating a Remote Patient Monitoring service, also known as Remote Physiologic Monitoring. Using CPT Code 99453, CMS reimburses approximately $19 to set up connected scales, connected blood pressure cuffs, connected glucose meters, and more per patient. The reimbursement also pays to train patients on how to use the connected devices to help monitor chronic illnesses, like diabetes, COPD, hypertension, and even some acute illnesses like COVID-19
CPT Code 99454
Billing Frequency Every 30 days* | $61.90
Device supply with daily recording and programmed alerts
With CPT Code 99454, physicians are reimbursed for the daily monitoring of patients using Remote Patient Monitoring, also known as Remote Physiologic Monitoring. Every day patients use the connected devices – such as scales and blood pressure cuffs for hypertension, oximeters for COPD, and glucose meters for diabetes – and healthcare data transfers to care professionals, showing the physician critical changes in a patient’s illness and allowing for new treatments to start before it becomes critical.
*Minimum of 16 days of monitoring required
CPT Code 99457
Billing Frequency Monthly | $48.29
Clinician spends 20 minutes in a calendar month on care management services
With CPT Code 99457, physician practices are reimbursed for doing what is at the heart of the practice – working with patients, but with CPT Code 99457, the patient interaction can be with other specific care professionals, not just the physician. This reimbursement does not require a patient visit, it is 20 minutes combined over one month to ensure the data being provided is keeping the patient healthy while receiving treatment for chronic conditions such as diabetes, COPD and hypertension.
CPT Code 99458
Billing Frequency Monthly** | $77.78
For subsequent 20-minute blocks beyond the initial 20 minutes (for 99457)
While CMS CPT Code 99457 reimburses physicians for the first 20 minutes of interaction with patients, CMS CPT Code 99458 covers the additional time needed to properly care for patients with Remote Patient Monitoring, also known as Remote Physiologic Monitoring. This ensures patients who are being treated for chronic illnesses and chronic conditions such as diabetes, hypertension, and COPD can receive extra care from their medical and/or healthcare professionals from wherever the patient is located.
**Fee after being billed twice, normally billed at $38.89
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