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Guide to CPT Code 99457

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The Remote Patient Monitoring CPT Code 99457 marks a pivotal step in enhancing remote patient care. In the evolving healthcare environment and the advancement in digital health platforms for RPM, this code establishes a foundation for medical practices to deliver comprehensive patient services while accessing Medicare reimbursement. By staying abreast with the latest guidelines and elevating patient care to new heights.

Introduction to CPT Code 99457

As the healthcare industry shifts towards digital solutions, understanding and utilizing healthcare code 99457 becomes a necessity. The 99457 CPT code covers the first 20 minutes of remote patient monitoring services, setting the stage for extended care under CPT Code 99458

Aligned with CMS guidelines, CPT Code 99457 provides a structured approach to remote patient care, enabling healthcare professionals to optimize patient outcomes while ensuring precise billing and reimbursement to those eligible.

Who Qualifies for CPT Code 99457?

All Medicare, Medicare-Advantage, and almost all Commercial Insurance remote patients are eligible to benefit from this Remote Patient Monitoring (RPM) code. This includes patients grappling with chronic ailments, including but not limited to diabetes, obesity, CHF, and hypertension.

The increasing reliance on remote patient care, especially in the wake of the COVID-19 pandemic, has broadened the scope, allowing more Medicare patients to benefit from this code.

Device Usage for CPT Code 99457

The digital age of healthcare is marked by advanced Remote Patient Monitoring devices under CPT Code 99457. These include:

  • Blood Pressure Monitors
  • Glucometers
  • Pulse Oximeters
  • Weight Scales
  • Thermometers
  • Continuous Glucose Monitors
  • Spirometers
  • Heart Rate Monitors

These devices enable efficient data collection and empower healthcare professionals to provide top-tier remote patient care.

CPT Code 99457 Billing Criteria

The process for billing CPT Code 99457 is tailored to reflect the essential care provided in the initial stages of remote patient monitoring. This code allows for billing of the first 20 minutes of non-face-to-face patient care per month, which includes time spent on data collection, review, and patient communication.

  1. 20-minute Interactive Call Requirement:  To bill for 99457, physicians or clinical workers need to do the monitoring for at least 20 minutes every calendar month. If an audit is conducted, the time spent on patient care must be recorded. Billing for 99457 should be avoided even if you have provided 20 minutes of care but have not had a live chat with the patient.   
  2. Independent Monthly Code: The RPM code 99457 can be billed separately from the other codes, but only once every calendar month. Compared to 94454, where a patient provides just 14 readings per month and is ineligible for billing, clinicians can still bill 99457 provided the interactive call and 20-minute requirements are met. 
  3. Reimbursement Rates: While costs will differ based on region, the national average reimbursement rate for 99457 is $48.13. You can find the physician fee schedule on CMS.gov for local reimbursements.

Let HealthArc Streamline Your CPT 99457 Billing Process

HealthArc’s system streamlines the billing and reimbursement for Remote Patient Monitoring (RPM), ensuring that your practice can efficiently document and claim these vital services. Our platform assists in tracking the time spent on patient care, making the billing process transparent and compliant with CMS guidelines.

For precise reimbursement rates and details, consulting cms.gov or a HealthArc specialist is recommended. Please request a free demo to learn about how we can help your organization achieve its remote patient monitoring, management, and billing goals in the long run.