Today, we will checkout the coding guidelines for remote monitoring cpt codes for medical coders. These codes needs have been added in 2019 and have separate coding guidelines. The three new CPT code 99453, 99454 & 99457 that cover remote patient monitoring equipment, setup and monitoring services are added.

These codes represent how health care professionals can use technology to connect with patients remotely while gathering important physiological data to more efficiently manage their care.

Coding tips for CPT code 99453, 99454 & 99457

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Description of CPT code 99453, 99454 & 99457

American Medical Association guidelines state that to report these codes, “the device used must be a medical device as defined by the FDA, and the service must be ordered by a physician or other qualified health care professional.”

As per Food and Drug Administration (FDA) definition a medical device is “an instrument, apparatus, implement, machine, contrivance, implant, in vitro reagent, or other similar or related article, including a component part, or accessory which is recognized in the official National Formulary, or the United States Pharmacopoeia, intended to use in the diagnosis of disease or in treatment of a disease or intended to affect the structure or any function of the body of man or other animals.

99453 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.

The initial set up fees is around 21$

99454 – Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days

The Device/transmission fee is around 69$ per month

99457 – Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

The Monitoring and treatment pays around 53$ per month

The key difference between 99453 and 99454 is that the former includes patient education on how to use certain devices; the latter does not. However, 99454 does have a time component (every 30 days).

These codes can be combined with chronic care managements services (CCM), which have been active for a few years.

Documentation required to bill 99453, 99454 & 99457 CPT code

In order to bill these new CPT codes the following requirement should be fulfilled:

The patient must opt-in for the service
Devices used must meet the definition of medical device, as defined by the FDA
The service must be ordered by a physician or other qualified healthcare professional
Monitoring must be greater than 16 days to be applied to a billing period
Data must be wirelessly synced where it can be evaluated
The data-monitoring services may be performed by the physician, by a qualified healthcare professional, or by clinical staff. Clinical staff may include, for example, RNs and medical assistants (subject to state law)

The new RPM (Remote patient monitoring) codes establish a distinct difference from current CMS telehealth reimbursement standards, which are largely built to accommodate rural patients. No such geographic restrictions are placed on the RPM codes, which are available for any patient as long as an in person office visit has occurred in the preceding year. Audio-video interaction between patients and physicians is not required for RPM reimbursement; rather, the coding is set up to facilitate non-face-to-face interaction.

Two more CPT codes 99451 & 99252

99451 : Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient’s treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time

99452 : Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or other qualified health care professional, 30 minutes