CPT Code 99454 is an important remote patient monitoring (RPM) billing code, addressing the monthly use of remote monitoring devices and the automated collection and transmission of physiological data. For telemedicine providers who provide virtual care, knowing and correctly applying this code is important to avoid unpredictable Medicare reimbursement and maintain compliance.
What Is CPT 99454?
CPT 99454 pays medical professionals for providing patients with FDA-cleared devices that automatically gather and transmit physiological information. The devices track vital signs, including blood pressure, glucose, oxygen saturation, respiratory flow, and body weight.
In order to bill CPT 99454, information has to be transmitted automatically without patient manual entry, and the patient has to send readings for a minimum of 16 days during a 30-day billing cycle. Monthly, this code is billed and is separate from the care management codes, such as CPT 99457 and 99458, that include clinical staff time and patient interaction.
Medicare Billing Requirements for CPT 99454
Medicare has strict guidelines to make sure that RPM services provide meaningful and high-quality care. Providers need to make sure the patient’s device captures and transmits data for at least 16 days during any 30-day period. Only devices with automatic transmission qualify. Not manual entry by patients.
In addition, CPT 99454 may be billed only once every 30-day period per patient, and billing is not allowed during times when the patient is an inpatient stay within a hospital or skilled nursing facility. The device must be supplied by the provider or organization, such that providers are not allowed to bill for patient-held consumer devices.
Following these rules strictly prevents denials of claims and issues of compliance.
What Counts as an Eligible Device?
Equipment that qualifies for CPT 99454 billing should comply with FDA Class I or II medical device regulations and possess current 510(k) clearance. Qualified equipment includes pulse oximeters, glucometers, blood pressure monitors, weight scales, and spirometers. The denominator is that the device should capture physiological data once daily and report it automatically without user input.
Consumer devices such as fitness monitors or applications that need manual data entry fall short of CMS’s requirements for reimbursement. An RPM vendor that supplies FDA-cleared, CMS-compliant devices makes sure your program’s devices adhere to all the necessary standards.
2025 Medicare Reimbursement for CPT 99454
For 2025, the average Medicare reimbursement for CPT 99454 is approximately $55 to $60 per 30-day billing period, varying slightly by location. This monthly payment applies once all billing criteria are met, including data transmission and usage requirements.
CPT 99454 can be billed under general supervision, that is, the provider need not be present during the procedure with the device. Providers should check the CMS Physician Fee Schedule periodically for the latest reimbursement information.
Documentation & Compliance Tips
Correct documentation is necessary to bill CPT 99454 with confidence and to survive possible audits. The date of beginning and end of the period of billing, type and serial number of the device, and the date when the device was activated and assigned to the patient should be clearly shown in the records.
It is very important to keep records proving that the device reported data automatically on a minimum of 16 days within the billing period. Records must also verify that the patient was not in the hospital or a skilled nursing facility for the duration.
Automated RPM systems, like those provided by RPM & CCM Health, can record and aggregate this documentation economically, lessening administrative burdens on your staff.
RPM & CCM Health’s Device Delivery & Monitoring Solution
It can be difficult to manage RPM devices and comply with the requirements of CPT 99454. That is why many healthcare organizations collaborate with RPM & CCM Health for a turnkey solution.
We offer FDA-cleared devices that are shipped directly to patients’ homes, with Bluetooth or cellular connectivity for automatic data transfer. Our clinical staff reviews data on a daily basis and increases care when needed. We also perform monthly billing and compliance monitoring to make sure that your claims are compliant with Medicare and payer requirements.
This model allows practices ranging from small clinics to systems of health to scale RPM programs effectively without the burden of handling device logistics or regulatory requirements.
If you are ready to streamline RPM delivery and drive reimbursement, partner with RPM & CCM Health. You can start your RPM program or schedule a demo.
Related Remote Patient Monitoring CPT Codes
CPT 99454 is one of a larger group of RPM billing codes. Knowing their interaction will help you in maximizing your RPM program and reimbursement.
CPT 99453 is billed for the initial setup and patient instruction for RPM, and CPT 99457 and 99458 bill clinical staff time for care management and patient communication outside of device data collection.
For a complete overview of all RPM services and billing, go to our remote patient monitoring overview page.
FAQs
Can CPT 99454 be billed without CPT 99453?
Yes. CPT 99454 is billed each month for device supply and data transmission, while CPT 99453 is a one-time code for initial device setup and patient training. It is very common to bill both when beginning an RPM program.
What if fewer than 16 days of readings are collected?
If the patient provides less than 16 days of data within the 30-day window, CPT 99454 cannot be charged. Exceptions can be made in cases of public health emergencies, but in general, regular data submission is necessary.
Can patients manually log their data?
No. Patient manual data entry does not satisfy Medicare’s requirements. Data should be automatically captured and transferred by the device.
Is patient consent required to bill 99454?
Yes. Medicare does require documented patient consent, may it be oral or written, prior to initiating RPM services.
Does Medicare cover multiple devices under CPT 99454?
Usually, only a single CPT 99454 may be billed for a 30-day period despite the use of multiple devices. Medical necessity must be well-documented if more than one device is used.
