2025 RPM CPT Codes and Reimbursement Rates

CPT Code 99453: Initial Setup and Patient Education

This code covers the one-time cost of setting up the RPM device and educating patients on how to use it.

• Reimbursement Rate: $19.73 (national average, non-facility).
• Billing Frequency: One-time per device.
• Key Requirement: Providers can bill this code after the patient uses the RPM device for 16 days within a 30-day period.

CPT Code 99454: Device Supply, Data Collection, and Reporting

This code reimburses providers for the cost of supplying RPM devices, transmitting patient data, and collecting/reporting that data.

• Reimbursement Rate: $43.03 (national average, non-facility).
• Billing Frequency: Once per patient per month.
• Key Requirement: The patient must use the RPM device for 16 days within a 30-day billing period to qualify for reimbursement.

CPT Code 99457: Initial 20 Minutes of RPM Services

This code reimburses providers for the first 20 minutes of RPM care management services delivered by clinical staff or physicians.

• Reimbursement Rate: $47.88 (national average, non-facility).
• Billing Frequency: Once per 30-day calendar month.
• Key Requirement: A portion of the 20 minutes must include interactive communication with the patient, which can be delivered via video, phone, email, or text message.

CPT Code 99458: Additional 20 Minutes of RPM Services

For patients requiring more care, this code reimburses for each additional 20-minute increment of RPM care management beyond the initial 20 minutes billed under 99457.

• Reimbursement Rate: $38.50 (national average, non-facility).
• Billing Frequency: Unlimited additional increments per 30-day calendar month.
• Key Requirement: Documentation is required for how time is distributed.

HCPCS Code G0511: For FQHCs and RHCs

FQHCs and RHCs can now use existing care management CPT codes alongside G0511 to reflect more precise services.

• Reimbursement Rate: $72.90 (national average, non-facility).
• Billing Frequency: Per 20-minute increment per patient, per month.
• Key Benefit: Providers in FQHCs and RHCs now have greater flexibility to bill for care management services, such as RPM, without being limited by bundled codes.

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Key Billing Requirements for RPM in 2025

To ensure compliance and maximize reimbursement for RPM services, providers must meet the following CMS billing requirements:

1. FDA-Approved Devices: All RPM devices must meet the FDA’s definition of a medical device.
2. Patient Consent: Patients must provide consent to participate in RPM services before receiving their devices.
3. 16-Day Rule for CPT Codes 99453 and 99454: Patients must use the RPM device for at least 16 days within a 30-day billing period. (Note: This requirement is expected to change in January 2026.)
4. HIPAA Compliance: All data collection and transmission must adhere to HIPAA regulations.
5. Interactive Communication: For CPT codes 99457 and 99458, at least part of the care management time must involve direct communication with the patient.
6. New Patient Evaluation: Providers must complete a patient evaluation before initiating RPM services for new patients.

Maximizing RPM Revenue

Leverage Technology to Meet Billing Requirements

RPM programs thrive on efficiency. Implement user-friendly devices and platforms that automate data collection, track time spent on care management, and generate compliant documentation. Tools like CCN Health’s RPM platform can help providers meet CMS requirements effortlessly while improving patient care.

Focus on Patient Adherence

Consistent patient participation is critical for RPM billing, especially with the 16-day rule for 99453 and 99454. Strategies to improve adherence include:

• Using devices with reminders to prompt patients to take readings.
• Offering clear instructions and regular follow-ups to troubleshoot issues.
• Providing personalized care plans that emphasize the importance of consistent data collection.

Train Your Team

Educate your clinical and billing staff on RPM requirements, documentation processes, and billing codes. Training ensures compliance, prevents billing errors, and maximizes revenue opportunities.

Outsource When Necessary

For practices facing administrative challenges, partnering with an RPM service provider can streamline operations, from device management to billing.