top of page

RPM CPT Codes explained - what are CPT codes?

Woman using RPM device for CPT codes

Remote patient monitoring (RPM) relies on accurate signalling, record-keeping, and patient management. Current Procedural Terminology, or CPT codes, provide healthcare practitioners and clinics with monitoring data to help maintain up-to-date records and expedite billing by automating invoicing based on the services delivered or events logged.

This standardized coding system ensures that every service involved in patient care, including hospitals, doctor's practices, and community-based healthcare teams, can log events, record medicine administration, or update a patient record when they have received specific treatment.

From billing to insurance claim processing, patient management, and follow-up appointments, CPT codes foster an environment where medical professionals have keen oversight of the care administered, with new codes introduced each year and others removed if they become redundant.

Wanda supports and reimburses both CPT® 99457 and CPT® 99458 through our leading RPM service and devices, ensuring accurate recording and reimbursement and streamlining billing and payment claims. Read more about our remote patient monitoring solutions here.

RPM CPT Codes Explained

A CPT code acts as a log of an event or action and can assist with automated billing, collating services delivered and referenced against pricing lists. Codes are issued and maintained by the American Medical Association, which also holds the copyrights to codes used in global healthcare.

There are four main categories of CPT code as follows:

  • Category one codes cover vaccinations administered, medications dispensed, devices assigned to a patient, healthcare services provided, and procedures carried out.

  • Category two CPT codes refer to quality of care services and performance monitoring – for example, a patient follow-up would be recorded against a category two code.

  • Category three codes are linked to new tech or emerging treatments, often used temporarily while a procedure or service is in an initial introductory phase.

  • The fourth and final category is PLA codes, which record lab testing.

Each code is specific, so for example, a hospital discharging a patient and relying on RPM to monitor their ongoing well-being and treatment success might log code 99214 when the patient returns for an office visit, code 99397 for a screening test for a patient over 65, or code 87635 if they have administered a COVID-19 test.

CPT Codes Used in Remote Monitoring

The Wanda Health RPM platform helps healthcare providers achieve better patient outcomes and improved services by recording and tracing changes in patient vital signs, symptoms, and other indicators.

For example, using RPM for patients at risk of chronic heart conditions allows medical practitioners to flag potential signs of increasing risk or early warnings that a patient may require preventative care before a critical event occurs.

Just as RPM has advanced significantly in recent years to provide new ways of delivering high-quality remote patient monitoring and support, CPT codes slot into the framework of remote and technological patient care and can be integrated into care management, used in diagnostic testing and wearable tech such as heart rate and blood pressure monitors.

Below we explain the prevalent codes used in RPM applications.

CPT 99453: Setting Up Patient Equipment and Providing Instructions on Usage

This code indicates that a practitioner has provided a patient with a monitoring device to keep track of their physical health, with instructions about how to wear or use the device to ensure the readings taken are accurate.

Read more about CPT 99453 reimbursement here.

CPT 99454: Monitoring Device Readings and Summarizing Data Recorded

Healthcare providers use this code once per month to log the billing event related to monitoring the data provided by the tracking device, including the transmission of data and collection of the information stored, and reporting on the outcomes via the appropriate clinician.

Read more about CPT 99454 reimbursement here.

CPT 99457: 20 Minutes Spent on RPM Coordination and Patient Consultations

Once an RPM device is in place, healthcare facilities log code CPT 99457 to note when consultations or communications have been provided to the patient for 20 minutes or more, again used once per month. Practitioners can then bill for this care coordination service, provided the communications were interactive and lasted at least the minimum time.

Read more about CPT 99457 reimbursement here.

CPT 99458: An Additional 20 Minutes of Communication and RPM Services

For every further 20 minutes of communications or RPM services, practitioners can log code CPT 99458 to correspond with the subsequent billing charge arising.

Read more about CPT 99458 reimbursement here.

CPT 99091: Interpreting RPM Data for 30 Minutes or More

This final code is used when a clinician or suitably qualified healthcare professional assesses the monitoring data transmitted by an RPM device and assesses the outcomes of the data, with at least 30 minutes allocated to collecting and evaluating the information to give rise to a billing event.

Devices used to log data as part of an RPM approach must be FDA-approved and upload data automatically without the patient needing to initiate reporting or recording of the metrics being tracked.

RPM devices associated with these CPT codes include devices that monitor weight, glucose levels, heart rate, pulse, blood pressure, weight, and lung capacity.

The Benefits of CPT Codes in RPM

RPM extends the accessibility of professional medical tracking and is an important service for countless healthcare providers, clinics, and hospitals, ensuring that patients with long-term, developing, and chronic conditions have always-on monitoring devices that can pre-warn the appropriate clinician of symptoms or changes in the physiological welfare of the individual.

One of the complexities of offering broad-scale RPM is that the billing and care tracking processes also need to scale, ensuring providers have a clear idea of which services have been provided. They can then ensure they raise billing documentation correctly or claim reimbursements through the Medicare system.

This healthcare administrative model can streamline billing and payment claims, with pre-set fees associated with the codes above as follows – note that these rates are indicative and can potentially change or vary depending on the area of practice:

  • CPT 99453 - $19.32

  • CPT 99454 - $50.15

  • CPT 99457 - $48.80

  • CPT 99458 - $39.65

  • CPT 99091 - $54.22

There are also other requirements for practitioners to claim reimbursement from Medicare. For example, claims against codes CPT 99453 and 99454 require the device to collect patient data and transmit the collated data every 30 days, capturing at least 16 days' worth of data.

Introducing CPT codes to RPM services ensures providers align their record-keeping with the standardized AMA system, with codes widely accepted by insurers and payers, helping with consistent reporting across bills, claim statements, and patient discharge documentation.

If you are a healthcare professional looking to capitalize on the many benefits of RPM implementation for your practice, get in touch with Wanda Health today and book a demonstration of our leading RPM services.


Popular Articles

bottom of page