The Current Procedural Terminology (CPT) Code 99457 is very important in allowing clinicians to be compensated for the initial 20 minutes of remote patient monitoring (RPM) treatment management services. The growth of remote care has made it increasingly important to understand this particular time-related code for various healthcare providers including medical practices, billing teams, and health institutions that have engaged the RPM modality for patient care.
What Is CPT 99457?
CPT 99457 is a time-based RPM CPT code that compensates providers for providing remote treatment management services of a minimum of 20 minutes within a calendar month. Unlike device setup or data transmission codes, 99457 only captures clinical time spent analyzing patient information and directly communicating with patients or caregivers.
To bill this code, care teams need to have interactive real-time communication with the patient, usually by phone or video conferencing and are required to take clinical actions based on the data being monitored. These services need to be provided by clinical staff like registered nurses or other trained personnel under general supervision from a billing provider.
This interaction allows clinicians to recognize trends, detect early warning signs, and actively modify care plans. This enhances results while decreasing hospitalizations and ER admissions. The work done has to be meaningful and documented and must represent medically necessary interaction based on device-determined health information.
Billing Requirements
To bill CPT 99457 the right way, healthcare professionals need to fulfill certain 99457 billing conditions set by CMS as well as most commercial payers:
- At least 20 minutes of the month should be spent in providing treatment management services based on RPM data.
- There needs to be two-way communication with the patient or caregiver in real-time during the month. This does not include asynchronous messaging or passive monitoring.
- RPM services need to be accompanied by device usage charged under CPT 99454, which takes the provision and transmission of data from a monitoring device.
- All time and clinical interactions need to be recorded in the patient’s medical record.
- Services may be provided under general supervision. This means that the onsite presence of the supervising physician is not required.
Keep in mind that providers can only charge one unit of 99457 per patient, per calendar month, no matter the time spent above 20 minutes. If more than 20 minutes is involved in treatment management, CPT 99458 can be used to report each additional 20-minute segment.
Medicare Reimbursement for CPT 99457
Medicare RPM reimbursement for CPT 99457 runs approximately $48 to $50 monthly on a national average. This reimbursement acknowledges the worth of ongoing, data-driven patient care and encourages practices to implement virtual chronic disease management.
All time, communication, and clinical interventions must be well documented to be eligible for reimbursement under Medicare. Providers must also meet the requirements that include:
- The 20-minute time requirement should be achieved or surpassed within the calendar month.
- At least one interactive communication session is required with either the patient or caregiver.
- Active device monitoring must be included in the RPM program, usually reported by CPT 99454.
Private payers can also have similar guidelines, but policies and rates of reimbursement can be different. Practices are urged to confirm payer-specific policies for both RPM codes as well as supervision requirements.
Qualifying Services for 99457
Not all activity is billable toward the 20 minutes for billing 99457. Time needs to be used on clinically significant services that have a direct correlation with patient care and information gathered from the RPM device. Examples of qualifying services that may bring the billing threshold are listed below:
- Analysis and review of transmitted physiologic data, such as weight trends, blood pressure, or blood glucose.
- Monitoring RPM data for indicators of decline or improvement.
- Adjusting medications or treatment regimens based on the data.
- Engaging patients or caregivers in real-time discussion about progress or issues.
- Offering individual education based on patterns or noncompliance in data.
- Care coordination with other physicians or referrals based on RPM data.
Administrative tasks such as logging into the system or making appointments are not included in the required time.
Documentation Tips
Proper documentation is necessary to verify billing, confirm compliance, and stay audit-ready. Practices must have a formal workflow in place to document all required parts in the patient’s record. The following documentations are highly recommended for 99457:
- Time logs reflecting a minimum of 20 minutes of treatment management.
- Mode of communication (telephone or video) and date/time of interaction with the patient.
- A clear clinical summary that reports choices made or education imparted based on the RPM data.
- Verification that the remote monitoring data was received and documented.
- Verification of patient or caregiver participation and compliance with the monitoring program.
Using platforms that automatically track time and prompt clinicians to document appropriately can make a significant administrative burden reduction.
Streamline RPM Management with RPM & CCM Health
Getting it done in-house effectively can be costly. From staff and paperwork to software and compliance, it takes specialized systems and personnel. That is where RPM & CCM Health steps in.
Our credentialed clinical staff provides 99457-compliant treatment management services under the oversight of your practice, while our technology platform helps in HIPAA-compliant communication, reporting, and time tracking.
Partnering with RPM & CCM Health gives you:
- Skilled clinical personnel providing reliable RPM care
- Documented, real-time patient outreach
- One place to monitor patient progress and RPM time
- Monthly reports and audit-ready summaries
- Easy integration with your EHR and billing infrastructure
We help practices in lowering operational costs while boosting patient engagement and revenue. Schedule a free RPM demo or join us and find out how we can help you in scaling your virtual care program.
Related RPM Billing Codes
CPT 99457 is one of a set of RPM codes that are used together to report various aspects of remote care. Knowing how they fit together is necessary for proper and thorough billing.
Related codes are:
- CPT 99454 – Device supply and transmission of data: This code reports the monthly use of an FDA-cleared RPM device, including transmission and data collection.
- CPT 99458 – Each additional 20 minutes of RPM treatment management: This is for extra time after the initial 20 minutes that is not included with 99457.
- Remote Patient Monitoring Overview: Get an overview of how RPM services operate, how they are billed, and how they enhance patient care.
FAQs
Can 99457 be billed without 99454?
No. CPT 99457 relies on device monitoring, which is billed separately using CPT 99454. Without continuous data transmission, 99457 cannot be reimbursed.
What qualifies as interactive communication?
Interactive communication must be two-way and in real time, like a live call or video encounter. Messaging is not enough.
Can nurses provide RPM services for 99457?
Yes. Clinical staff, such as RNs and LPNs, can provide 99457 services under general supervision of the billing provider.
Is patient consent required for 99457?
Yes. Patients need to provide verbal or written consent before beginning RPM services. This consent has to be noted in the medical record.
