CPT 99457: RPM Treatment Management — First 20 Minutes.
CPT 99457 covers the first 20 minutes of clinical staff time per calendar month spent on remote physiologic monitoring treatment management services. This includes reviewing and interpreting monitoring data, making clinical decisions based on the data, and engaging in interactive communication with the patient or caregiver. The interactive communication requirement means at least some of the 20 minutes must involve live contact with the patient.
Quick Answer
What is CPT 99457?
CPT 99457 is the Medicare billing code for RPM treatment management, covering the first 20 minutes of clinical staff time per calendar month spent reviewing remote monitoring data and communicating with the patient. It reimburses $51.77 per month under the 2026 CMS fee schedule (RVU 1.55). The code requires interactive communication with the patient or caregiver — passive data review alone does not qualify. Clinical staff perform the work under physician supervision. For months with only 10-19 minutes, the new 2026 code 99470 can be billed instead.
Documentation
Documentation requirements.
Total time spent on RPM treatment management activities totaling 20+ minutes
Description of physiologic data reviewed and clinical interpretation of findings
Record of interactive communication with patient or caregiver including date, duration, and mode (phone, video, secure message)
Clinical decisions made based on the monitoring data and rationale
Care plan updates or treatment modifications resulting from data review
Credentials of the clinical staff performing the service
Scenarios
Common billing scenarios.
Nurse reviews blood pressure data and calls patient
BillableAn RN spends 10 minutes reviewing a patient's blood pressure trends showing elevated readings, then calls the patient for a 12-minute discussion about medication adjustments and lifestyle changes. Total interactive management time is 22 minutes, exceeding the 20-minute threshold.
Passive data review without patient contact
Not BillableA clinical staff member spends 25 minutes reviewing RPM data dashboards and documenting trends but does not contact the patient or caregiver. Because 99457 requires interactive communication, passive review alone does not qualify.
Multiple short interactions totaling 20+ minutes
BillableOver the course of a month, a nurse has three brief phone calls with a patient (8, 7, and 6 minutes) to discuss glucose readings and insulin adjustments. The cumulative 21 minutes of interactive management meets the threshold.
Clinical staff accumulates only 14 minutes of management time
Not BillableA care coordinator spends 14 minutes total on RPM management during the month, including one 10-minute patient call. The 20-minute minimum is not met, so 99457 cannot be billed. Consider billing the new 2026 code 99470 (10-19 minutes) instead.
FAQ
Common questions about CPT 99457.
What is CPT 99457?
CPT 99457 is the Medicare billing code for Remote Patient Monitoring (RPM) treatment management, covering the first 20 minutes of clinical staff time per calendar month spent reviewing device data, interpreting results, and communicating with the patient. It reimburses $51.77 per month under the 2026 CMS fee schedule.
How much does CPT 99457 reimburse in 2026?
CPT 99457 reimburses $51.77 per patient per month under the 2026 CMS national non-facility rate, based on an RVU of 1.55 and the 2026 conversion factor of $33.40. When combined with 99454 (device supply at $52.11), the base RPM billing stack totals approximately $104 per patient per month.
Does 99457 require interactive communication with the patient?
Yes. CPT 99457 requires interactive communication with the patient or caregiver as part of the 20-minute minimum. Passive data review alone does not qualify. Interactive communication includes phone calls, video visits, and secure messaging. The communication must be documented with date, duration, mode, and clinical content.
What is the difference between 99457 and 99470?
Both codes cover RPM treatment management, but differ in time thresholds. CPT 99457 requires 20+ minutes per month ($51.77), while 99470 (new for 2026) covers 10-19 minutes ($26.05). The codes are mutually exclusive — bill 99457 for 20+ minutes or 99470 for 10-19 minutes in a given month. Code 99458 (additional 20-minute increments) can only be added to 99457, not 99470.
Can 99457 be billed without 99454?
Yes, 99457 and 99454 are independent codes. However, in practice they are almost always billed together. 99454 covers the device supply and data transmission, while 99457 covers the clinical staff time reviewing and acting on that data. Billing 99457 without 99454 would be unusual and may trigger payer scrutiny.
Who can perform the clinical work billed under 99457?
The clinical monitoring and interactive communication can be performed by clinical staff — including RNs, LPNs, MAs, and care coordinators — under the general supervision of the billing practitioner (physician, NP, or PA). The billing practitioner must have an active treatment plan for the patient but does not need to personally perform the data review.
Related Codes
Other CPT codes.
CCM Initial 20 Minutes
$62.00 • Once per calendar month
RPM Device Supply (16+ Days)
$52.11 • Monthly (per 30-day period)
RPM Initial Setup (One-Time)
$21.71 • One-time per episode of care
RPM Clinical Review (Additional 20 Min)
$41.42 • Monthly (per calendar month, add-on to 99457)
Complex CCM Initial 30 Minutes
$86.00 • Once per calendar month
PCM Physician Base (30 Min)
$88.00 • Once per calendar month
BHI Care Management (20 Min)
$53.00 • Once per calendar month