Current procedural terminology, or CPT codes, are widely used in remote patient monitoring (RPM), ensuring practitioners and providers use accurate coding to submit claims and reports to claim the appropriate reimbursements.
New codes are periodically introduced, and old codes are superseded. CPT 99457 is one of a series of codes introduced in January 2022 with some changes that RPM service providers should be aware of.
Today we look at what services CPT 99457 applies to, the conditions attached, and how to ensure you log and record time spent monitoring and analyzing RPM reports extracted from RPM devices and consulting with your patients.
The Importance of CPT Codes in RPM
CPT codes standardize reporting systems, with defined reimbursements linked to each service, provided the medical practice or facility delivers the service in line with the parameters. For example, an RPM care service can submit a reimbursement claim for CPT 99457 once per month.
These codes are invaluable in expediting and automating much of the billing and claim cycle while ensuring remote health monitoring companies claim all the reimbursements they are entitled to.
Related Reading: What is remote patient monitoring?
CPT code 99457 Description
Code 99457, which we are examining in this guide, is used for the initial management of patient treatment requiring at least 20 minutes of time clinicians spent working on patient care and communicating with the individual.
Practitioners, clinics, and hospitals can log CPT 99457 after they have dispatched a compliant RPM device to their patient, which covers the time they spend treating the patient, whether interpreting the results transmitted by the device, advising the patient on how this affects their ongoing care plan, or explaining the appropriate lifestyle or medication changes they can make to improve the readings.
Note that as a CPT code used in RPM applications, these dialogues can be delivered remotely through video or phone calls and do not need to be in person to be a claimable service.
Claiming Reimbursements for CPT 99457
Wanda supports and reimburses CPT® 99457 through our leading remote patient monitoring service, ensuring accurate recording and reimbursement.
Currently, the standard reimbursement of CPT 99457 services is an average of $48.80, although this can vary between regions. Claims are limited to one per month per patient. Any medical professional, such as a doctor, healthcare consultant, or other qualified practitioner, can use the code when they believe this is in the interests of their patient's care and well-being.
Practitioners can provide tailored monitoring and consultative care levels, although higher-level RPM monitoring may qualify for a greater reimbursement value through CPT 99091.
As we have explained, CPT 99457 refers to 20 minutes or more of time spent with a patient or managing their treatment. CPT 99091 differs because it relates to time spent collecting and analyzing RPM device data, requiring at least 30 minutes of care delivery, with at least one communication event required to be claimable once per month.
Eligibility Criteria to Claim CPT 99457
The nature of RPM and the diversity of consultations and discussions a practitioner may have with a patient mean that CPT 99457 covers a broad scope of activities, events, and services.
For example, a healthcare provider could log CPT 99457 if they:
Arrange a follow-up meeting, video call, or phone call with their patient to discuss the results of their RPM device readings or provide advice and information about how they have interpreted the outcomes.
Review RPM device outputs, or discuss changes to symptoms monitored with a specialist or other clinicians within their facility or healthcare service.
Recommend changes to medications, dosages, lifestyle changes, dietary adjustments, or any other aspects of the patient’s condition management in light of RPM tracking data.
General monitoring of RPM data collected also counts towards CPT 99457, although the practitioner must record 20 minutes or more of consultative, analytical, or communicative activities.
Meeting CPT 99457 Patient Communication Requirements
The regulations indicate that CPT 99457 communications must be interactive, normally a phone or video call where patients can listen, ask questions, respond to suggestions, and establish a dialogue with their healthcare provider.
Practices can log activities undertaken, such as monitoring RPM data, ensuring they have sufficient audit evidence of activities to prove their eligibility for CPT 99457 reimbursement.
Some forms of communication, such as leaving a patient a voicemail or sending a message through text or another messaging service, are not considered interactive. Therefore, if a healthcare provider spends more than 20 minutes working on patient care but does not record an interactive communication, they cannot bill CPT 99457.
Billing CPT 99457 Alongside Other RPM CPT Codes
CPT 99457 is billable once a month but is not reliant on the healthcare provider billing other claims. For example, CPT 94454 refers to RPM device monitoring and data analysis, claimable when a practitioner extracts data from RPM devices and determines how the data collected affects the patient care plan.
The provider must log data from at least 16 days of each month, so if the RPM device transmits fewer readings, the practice cannot bill CPT 94454. However, they may still claim CPT 99457 if they have conducted at least 20 minutes of care and organized an interactive call.
When a healthcare provider exceeds the 20 minutes of monthly RPM services, they can bill CPT 99458 for each additional 20 minutes.
Time Tracking for RPM CPT Code Claims
Practitioners need to ensure their patients are aware of the interactive communication requirement and are happy to engage in a conversation at least once per month as part of an ongoing care management service.
They must also ensure they use a suitable software or tracking system to log the time spent on the patient's care and evidence that they have adhered to the 20-minute minimum required to claim CPT 99457.
Communications should be recorded, with the assurance that the organization will have sufficient evidence of phone calls and video calls, care plan adjustments, recommendations made, and other services in an audit scenario.
Digital software platforms are the best option, where healthcare professionals understand how to use these tools to record every aspect of patient care delivered and can demonstrate compliance and precise monitoring.