CPT 99458 is one of the four main codes used to raise billing claims for Remote Patient Monitoring (RPM) services. This code is used in addition to CPT 99457 when practitioners or clinicians have provided a patient with additional monitoring time within the 30-day billing cycle or per calendar month.
Healthcare providers can claim CPT 99458 only when they have already claimed CPT 99457 for the same patient and within the same billing period. CPT 99457 applies when a physician or other medical professional has provided 20 minutes of services in compliance with the requirements.
Additional support time of 20 minutes or more qualifies for an additional claimable value, ensuring practitioners are appropriately compensated when they spend more than the initial 20 minutes analyzing patient data, consulting, or discussing their treatment plans.
Billing Criteria for CPT 99458
As with all Medicare billing codes, there are several criteria a healthcare service needs to meet to claim payment against CPT 99458. These include:
Providing live interactive consultations with the patient – normally in the form of a video call or contact through a live virtual care platform. In essence, an email, voice message, or written communication is not eligible.
The 20 minutes of service delivery should relate to care management. Video calls do not necessarily need to be 20 minutes long, but the total care management should comprise 20 minutes of a physician's time or more.
Claiming CPT 99458 for interactions lasting from 21 to 40 minutes per month, with CPT 99457 claimed for the initial 20 minutes of care delivery. Practices may be permitted to claim CPT 99458 twice, but the second instance must be a separate interaction with a distinct live communication.
Provided each subsequent 20 minutes meets the criteria, the service can submit more than one claim. However, the recommendations are normally to remain within a maximum of two units of CPT 99458 per billing cycle, providing up to 60 minutes of care management. In cases where there is a medical need for more extensive monitoring or liaison, a service can bill CPT 99458 as many times as necessary.
Eligibility for CPT 99458 Claims
Any qualified healthcare provider, such as a physician, clinician, or consultant, can enroll a patient into an RPM program and provide patient liaison services that qualify for CPT 99457 and, subsequently, CPT 99458 billing.
Monitoring and interactions may be completed by any clinical staff, outsourced provider, or nursing colleagues, including medical assistants in some states – although this may vary depending on your jurisdiction.
Activities that count towards the 20 minutes of clinical monitoring time include anything that involves analyzing and monitoring patient RPM readings, communicating and educating the patient, updating treatment plans and prescriptions, and consulting with other healthcare colleagues – providing at least one live dialogue with the patient is delivered.
Reimbursement rates vary between areas, with an average of $38.68 in 2023, and healthcare service providers implementing RPM can verify the local rates through the CMS physician fee schedule.
Patient Criteria for RPM Services Eligible for CPT 99458 Reimbursement
CPT 99458 applies to any patient who has been enrolled in an RPM program and where this is deemed medically necessary by their physician or practitioner. Common conditions that require ongoing, monthly monitoring include:
Hypertension
Obesity
Types 1 or 2 diabetes
Chronic heart failure
Devices used to collect the data monitoring through RPM and inform the interactions between the practitioner and patient can include blood pressure cuffs, blood glucose monitors, digital weight scales, and pulse oximeters – all of which are available from Wanda Health.
Note that CPT 99458 must be used in conjunction with CPT 99457 and does not cover the cost of the RPM device itself or the initial setup and patient instructions on device usage. Healthcare services should instead bill CPT 99454 for the supply of the device.
Best Practice Standards for Extended RPM Care Delivery
Many patients can be effectively monitored and treated with 20 minutes of monthly engagement time with their physician or care team. However, those with more complex conditions or greater needs for interactions, tracking, and communications may benefit from additional support, billable in 20-minute increments, as discussed.
Common reasons for a practitioner to recommend additional contact time and care management could include:
Patients with higher RPM measurements or more frequent data readings that put them into a high-risk category.
Individuals with several medications or needing cross-condition care to manage multiple illnesses or health concerns.
Vulnerable patients who require greater support and more regular touch points, often those who live alone and need assurances about their health and medications or more frequent assistance to ensure they are comfortable using their RPM devices.
Healthcare services are advised to assess patient needs to ensure they allocate sufficient time – since not every patient will be well-served with the standard 20 minutes of care engagement.
Practitioners, outsourced RPM providers, and more junior clinical staff engaging with patients under the supervision of a physician should also ensure they track the time spent with each patient.
In some cases, communications and time invested in care assessments and RPM data tracking may exceed 20 minutes, and time tracking can facilitate more accurate resource allocations to ensure services can claim the appropriate reimbursements.
Managing Healthcare Patients With Higher Care Needs
Where a healthcare provider routinely identifies that the same patient has met the criteria for CPT 99458, this may be indicative of additional or elevated care needs, which can be met through augmented patient education or coaching around the use of an RPM device and how to access results through the virtual care platform.
Clinicians may also suggest lifestyle changes or make referrals where they have concerns about the independence or overall welfare of a patient and where frequent interactions demonstrate a need for greater at-home assistance.
However, provided the RPM care provider can evidence that they have focused on patient engagement and meeting the billing requirements of CPT 99454 and CPT 99457, they can claim CPT 99458 as necessary, whether on an ad hoc or regular basis.