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CPT Code 99453: Description, Reimbursement and Billing Guidelines

doctor using CPT code 99453

CPT code 99453 is one of four codes introduced to enable healthcare practitioners and medical service providers to claim reimbursements for remote patient monitoring, or RPM.

Understanding CPT codes, the eligible interactions or services that qualify for reimbursement, and the requirements is essential to ensure clinicians, physicians, and community care organizations submit accurate billing requests with the appropriate supporting documentation and evidence available.

CPT 99453 relates to the initial set-up of an RPM device and educating the patient about when and how to take their readings – ensuring they are comfortable using the device, know how it works, and are confident that they are taking accurate measurements that are then transmitted to their healthcare provider, or the outsourced RPM provider.

Description and Applications for CPT Code 99453

As we’ve covered, CPT 99453 is the billing code used when a healthcare service has met the requirements to claim reimbursement for the set-up of an RPM device and providing education to the patient.

The Medicare guidelines state that billable events relate to remote monitoring devices that measure physiologic parameters such as blood pressure, respiratory rate, or weight. The education delivered does not have to meet any particular time threshold, and supervision of the set-up process can be provided by a clinician, support staff, or another appropriately informed person who can answer questions.

RPM devices that are eligible for reimbursement must be FDA-recognized and might include the following:

Healthcare providers can also submit claims for RPM services using CPT 99453, where they have provided a patient with a secondary device that transmits readings to the relevant database – although advanced RPM devices with cellular transmission functionality normally operate as standalone devices.

Claiming Reimbursements for CPT 99453

Medicare publishes guidelines and standards that dictate the terms against which an RPM service is billable – medical service providers must ensure they comply with these requirements to ensure they claim the full amount owing and to be able to provide confirmation of the service provided if necessary or during an audit process.

CPT 99453 covers the set-up when a device is first deployed to an RPM patient, which might mean showing them how to check their blood oxygen or blood pressure.

Patient support can be provided in-person or virtually, and the provider offering RPM device education should verify that the patient can activate the device independently and walk them through taking their first reading before they conclude the session.

While exact reimbursement rates vary, the average value of CPT 99453 in 2023 is $19.32 per device. Practitioners can only use CPT 99453 once for each patient when the new RPM device is provided.

Additional codes like CPT 99454 and CPT 99457 are then used to submit billing for monthly services, the costs of supplying an RPM device, and treatments or consultations provided from then onward.

Eligibility Criteria to Claim CPT 99453

The ordering provider must be a qualified healthcare professional, clinician, or physician with the medical expertise to decide when an RPM device is required and which device or devices are suitable for the patient.

RPM devices can be deployed without a formal diagnosis. They may be deemed appropriate if a physician or clinician believes the device will be medically necessary and beneficial for the patient, their long-term health, or the management of other underlying, related, or suspected conditions.

Practitioners commonly recommend RPM for monitoring chronic diseases such as hypertension, heart failure, and diabetes. They may also use RPM to track the health and overall well-being of patients with other indications or to verify whether a medication is working as expected or is having any potential side effects.

As a summary of the other key requirements to use CPT 99453:

  • The CPT code can be used only once per patient and device. However, if a healthcare provider issues two or more RPM devices to a patient, they may be able to bill CPT 99453 twice, provided they submit the billable event log in two separate months – you cannot claim CPT 99453 twice in the same month.

  • Patients who are discharged from RPM when their care comes to an end may be re-enrolled in an RPM program. In this instance, the provider can bill CPT 99453 a second time when a new RPM device is dispatched and set up.

  • Patients should begin taking their readings immediately. RPM services only become billable when the patient has taken measurements for 16 days within a 30-day period. Therefore, a healthcare service cannot bill CPT 99453 until 16 days have passed, with 16 separate readings. This rule also applies to billing CPT 99454, related to care management.

  • Minimum time requirements apply since it would otherwise be possible for a healthcare provider to deploy an RPM device to a patient and provide education and support during the set-up process but for the patient to not engage with the program or not take their daily readings as requested.

Meeting the Billing Requirements for CPT 99453

The set-up period is important to ensure patients engage with RPM and are familiar with the use of their device to take accurate measurements. Onboarding does not necessarily have to be in-person but should always be interactive.

Patients should be able to ask questions, take their first reading under supervision, and understand when to take each measurement, with guidance about the best frequency or timings of readings to provide precise monitoring data for their practitioner.

Flexible set-up options are considered best practice, catering to the needs and preferences of various patient groups. Many opt for virtual or remote set-up, in line with the characteristics of RPM itself, with the convenience of receiving an RPM device at their home and communicating with an adviser via video call while they use the device for the first time.

Third-party providers can deliver set-up and education services as eligible billable events for CPT 99453, acting with the authorization of the prescribing practitioner or service provider.

Find out more about CPT billing codes here. As a leading remote monitoring company in the US, Wanda supports CPT® 99453, CPT® 99454, CPT® 99457 and CPT® 99458.


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