What Does CPT Code 99454 Cover?

CPT Code 99454 reimburses providers for:

• Continuous supply of RPM devices
• Daily collection and transmission of physiological data
• Automated alert transmission to healthcare providers
• Data review and reporting within a 30-day period

With CCN Health, these processes are automated, ensuring real-time data sync without manual input.
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Who Qualifies for CPT Code 99454?

All Medicare patients who require remote patient monitoring qualify for CPT Code 99454. Chronic conditions are not required, meaning both acute and chronic patients can receive RPM services.
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Who Can Bill for CPT Code 99454?

RPM services under CPT 99454 must be:

• Ordered by a physician or qualified healthcare professional
• Performed under the provider’s supervision
• Monitored for at least 16 days within a 30-day period

CMS defines qualified healthcare professionals as those with the necessary training, licensure, and facility privileges to report professional services independently.
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Billing and Reimbursement for CPT Code 99454

What Can Be Billed Under CPT Code 99454?

CPT Code 99454 covers:✅ Device supply and maintenance✅ Data collection and transmission✅ Automated alerts to healthcare providers

This code can only be billed once per 30-day period per patient, regardless of the number of devices used.

What Is the Reimbursement Rate for CPT Code 99454?

The national average reimbursement for CPT Code 99454 is $43.03 per patient per month for at least 16 days of monitoring.

How Often Can CPT Code 99454 Be Billed?

Providers can bill CPT 99454 every 30 days, but only once per patient per month, even if multiple devices are used.

Device Requirements for CPT Code 99454

To qualify for CPT Code 99454, an RPM device must:

• Meet the FDA’s definition of a medical device
• Be used for at least 16 days per month
• Collect and transmit HIPAA-compliant data

Common FDA-cleared RPM devices include:

• Blood pressure monitors
• Scales
• Blood glucose meters
• Pulse oximeters

With CCN Health, providers ensure compliance with CMS regulations while simplifying device management.

Third-Party RPM Service Providers and CPT 99454

CPT Code 99454 allows third-party RPM providers to assist with:

• Device setup and education
• Data review and transmission
• Billing and compliance management

Providers can bill CPT Code 99454 under “incident to” billing rules, meaning third-party companies like CCN Health can support RPM services under the physician’s supervision.

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