What Does CPT Code 99457 Cover?

CPT Code 99457 reimburses for:

• At least 20 minutes of real-time, interactive communication with patients
• Remote monitoring of physiological data
• Care coordination and intervention as necessary
• Clinical decision-making based on transmitted data

With CCN Health, providers can easily track, manage, and document RPM services while ensuring compliance with CMS regulations.

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Who Qualifies for CPT Code 99457?

All Medicare-covered remote patients qualify for CPT Code 99457. Unlike other RPM codes, a chronic condition is not required—RPM services can be provided for both acute and chronic conditions, including:

• Chronic illnesses (e.g., diabetes, hypertension, COPD)
• Post-surgical recovery patients
• Geriatric patients with mobility limitations
• Patients in rural areas needing remote monitoring
• Acute conditions requiring close monitoring (e.g., COVID-19)

Who Can Bill for CPT Code 99457?

RPM services under CPT 99457 must be:

• Ordered by a physician or qualified healthcare professional
• Performed under general supervision
• Provided with at least 20 minutes of interactive communication per month

According to CMS, a qualified healthcare professional includes those who are licensed and authorized to provide RPM services within their scope of practice.

Billing Requirements for CPT Code 99457

Providers must meet the following criteria to bill CPT 99457:

• The RPM device must meet FDA’s definition of a medical device
• Patients must opt into RPM services before receiving a device
• A patient evaluation is required for new RPM enrollees
• Data collection must be HIPAA-compliant
• At least 20 minutes of interactive patient communication is required per month

What is the Reimbursement Rate for CPT Code 99457?

The national average reimbursement for CPT Code 99457 is $47.88 per patient per month, with additional billing opportunities under CPT 99458 for extended service time.

How Often Can CPT Code 99457 Be Billed?

CPT 99457 can be billed once per patient per 30-day period, provided the 20-minute communication requirement is met. Additional time beyond 20 minutes can be billed using CPT Code 99458.

FDA Clearance and Device Requirements for CPT 99457

To qualify for CPT Code 99457, devices must be medical devices as defined by the FDA. While FDA clearance is not required, some providers may prefer FDA-cleared Class II RPM devices to ensure accuracy and compliance.

Common RPM devices used for CPT 99457 billing include:

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

With CCN Health, providers gain access to seamless device integration, ensuring automated data collection for compliant billing.

Can a Patient Use Multiple RPM Devices Under CPT 99457?

Yes, patients may require multiple RPM devices based on their conditions. However, providers can only bill CPT Code 99457 once per patient per 30-day period, regardless of the number of devices used.

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