CPT 99091. CPT 99457. CPT 99453. You may have heard these codes before, or maybe they just look like a jumble of letters and numbers. Either way, this guide was put together to help you understand remote patient monitoring (RPM) CPT codes and their uses.
Current procedural terminology codes, or CPT codes, are a set of codes used to categorize medical services and procedures, and are frequently used for billing purposes. CPT codes have been in effect since 2018, and the American Medical Association recently made some changes to them in 2022. The CPT codes most commonly used in RPM are CPT 99091, CPT 99453, CPT 99353, CPT 99457, and CPT 99458. Below is a synopsis of each of these five CPT codes:
CPT code 99091 is meant to cover the collection and interpretation of remotely collected data. This code is billed monthly and covers 30 minutes of patient-provider interaction. It also requires at least one point of communication between the physician and patient, whether that be over the phone, through email or via a video call. It is also important to note that this code can only be billed by a qualified health professional, and not any member of staff.
CPT code 99453 is used to bill for initial set-up time, including onboarding. This is a one-time cost, and thus can only be billed once per treatment period.
CPT code 99454 is intended to cover the supply and use of the remote patient monitoring devices, and is generally billed every 30 days.
CPT code 99457 is used to reimburse for time spent by physicians monitoring and interpreting patient data. This is a calendar month code–and not an every 30 day code–that requires at least 20 minutes of time per month.
CPT code 99458 is similar to CPT code 99457, but is an add-on code and used to bill additional time spent by the physician monitoring and interpreting data. This is also considered a calendar month code.
The average reimbursement rate for these codes varies, so check out our post on rates according to the 2023 Medicare Physician Fee Schedule.
CPT codes may seem daunting at first glance, but they’re actually quite accessible for both patients and providers. Check out our other blog posts to learn more about remote patient monitoring reimbursement and the benefits of RPM.