Frequently Asked RPM Billing Questions (FAQ)

• CPT® code 99453 for initial patient set-up and education
• CPT® code 99454 for 16 days of patient data transmission (in a 30-day period)
• CPT® Codes 99457 and 99458 for clinical monitoring time per calendar month

CPT® codes 99457 and 99458 cover the time Vital View's fully managed RPM services team or your clinical team spends monitoring patients and delivering remote care and patient education.

YES! Independent Monthly Code. 99457 can be billed one-time every calendar month, but can be billed independent of the other RPM codes. In other words, if a patient only submits 14 readings in a month and therefore isn’t eligible to bill 94454, you can still bill 99457 as long as you have met the 20 minute and interactive call requirements. Additional time spent on clinical monitoring may be eligible for reimbursement using CPT® code 99458.

Most billers use the first day of the month or the last day of the month when submitting.

The 20-Minute and Interactive Call Requirement.  To bill 99457, clinical staff must spend a minimum of 20-minutes in a calendar month conducting the monitoring activities. Time spent on patient care must be documented in case of an audit. In addition, the clinical staff must have at least one live or synchronous, two-way, interactive call with the patient. To qualify as a synchronous communication, this must be at minimum a live phone call or video call. Text messages and/or voicemails do not meet the interactive call requirement. Even if you have met the 20-minutes of care time but have not have live conversation with the patient, you should not bill 99457. 

Time Requirements. 99458 can be billed once you have met the requirements (20 minutes of engagement and one live synchronous call) for 99457. In other words, you can bill 99458 for minutes 21-40 of medically necessary patient engagement. You can also bill 99458 twice if you meet the 20-minute requirement, or for minutes 41-59.  Note: you must have a second live or synchronous call to bill 99458.  

• What Activities Contribute to Clinical Monitoring?  In general, any time spent monitoring patient data or communicating with patients about their health can count toward 99457. All activities need to be documented. They include:
   

  • Monitoring and analyzing patient data

  • Sending any patient communication (for example, text or phone)

  • Providing ongoing patient education or communicating patient updates and patient escalations

  • Reviewing a patient’s readings with other members of the care team

  • Making changes to a patient’s care plan or medications

Reimbursement Rates. According to the CMS CPT© Guidebook, Professional Edition 2024, the national average reimbursement rate for 99457 is $48.13 and  99458 is $38.64, but rates will vary by geography and location. Vital View does not interpret or define the CMS RPM codes and recommends that you refer to your billing specialist or MAC office for guidance. Local reimbursements can be located at CMS.gov physician fee schedule.

Clinical monitoring time is all about connecting with patients and building trusted relationships. When patients understand that a clinician is available to check on them every day and are truly invested in their care, they become more involved in their health.  Here are some specific best practices to follow:

• Set Expectations for Interactive Call at Patient Onboarding:  While expectation-setting at the RPM onboarding appointment often focuses on the number of readings that patients take, it’s critical to also set expectations for ongoing communication. Patients need to understand that they must speak with a member of the care team every month to review their progress and discuss their care plan.

• Automated Time Tracking: Your RPM platform may automatically track time towards both the 20-minute time requirement and the interactive call. In-platform communication tools like texting and live-calling capabilities are important to make it as easy as possible to track the time spent monitoring each patient. The monitoring team should also know how to add manual time, or edit automatically captured time, if they do need to conduct monitoring activities outside of the platform, such as calling a patient from the office line or personal cell phone so that those engagement activities are always tracked and you don’t lose track of billable time.

• Choose the Right Staffing Model:  Maintaining high levels of engagement time is dependent on dedicating enough staff time to interacting with RPM patients on a daily basis. For many practices, it can be difficult to have their staff manage remote monitoring as well as in-office priorities. In our experience, one full time clinician can monitor 150-200 patients. If your practice does not have sufficient clinical resources, you should consider an RPM partner that provides clinical monitoring. Your partner’s team can act as an extension of your own staff, expanding your practice’s clinical capacity.  We have found that practices using partner-managed RPM typically save overhead expenses related to providing these services to patients.

• Make Calls Early in the Month and Get to Know Your Patients Schedule:  The interactive call requires planning so you can reach patients when they are most likely to be available, since voicemails do not meet the interactive requirement. We recommend reaching out to patients early in the month so there is time to make repeated attempts before the end of the month. We also suggest getting to know your patient’s preferences for days of the week and/or times in the day that works better for them. Ideally your remote care platform should have a place to note your patients’ availability and preferences for when to receive calls. 
  

• Make the Interactive Call Meaningful: Patients will be more likely to pick up the phone and engage with their care team members if they find the calls to be helpful and supportive. Getting to know patients and asking about their routines, friends, family, and other meaningful connections such as pets or other being part of community groups can help build trusted relationship with patients. In addition, care team members should help patients understand how they can make changes to their diet and lifestyle to improve their health. 

CPT® code 99454 covers the automated data transmission from the patient’s device to the practice’s Remote Physiologic Monitoring (RPM) platform. The code requires that patients take a minimum number of readings per month to be eligible for reimbursement. 

YES! 99454 is Independent of the Communication Monthly Codes 99457 and 99458.

The 16-Day Requirement. To bill 99454, the patient must transmit at least 16 days of readings within 30 days. These readings must be taken on separate days, so if a patient takes readings twice a day for 10 days, that would only count as 10 days of readings. The reading days do not need to be consecutive, but patients are more likely to be successful if they take their readings each day.

Most billers put the last date of the 30-day rolling period from the install date.  While this can take some time to figure out, Vital View's billing report automatically gives you this date.

• Billable Every 30-Days. 99454 can be billed once every 30 days. It’s not tied to the calendar month, though many practices choose to bill on a calendar basis to simplify billing.
  
  
• Patients with Multiple Devices:  If a patient has multiple devices, the total days of readings still must be 16. However, readings from both devices will count toward the 16-day requirement. For example, if a patient takes a blood pressure and weight reading on the same day, that would count as one day of readings. Alternatively, if a patient takes 8 days of blood pressure readings and 10 days of weight measurements, this would count as 18 days, as long as the days are not double counted. All devices must meet the FDA definition of a medical device, and we recommend choosing an RPM partner that provides FDA-regulated devices for at-home use. 

Patients with Multiple Devices:  If a patient has multiple devices, the total days of readings still must be 16. However, readings from both devices will count toward the 16-day requirement. For example, if a patient takes a blood pressure and weight reading on the same day, that would count as one day of readings. Alternatively, if a patient takes 8 days of blood pressure readings and 10 days of weight measurements, this would count as 18 days, as long as the days are not double counted. All devices must meet the FDA definition of a medical device, and we recommend choosing an RPM partner that provides FDA-regulated devices for at-home use. 

We strongly recommend setting expectations for each patient’s engagement and participation in your RPM program during the onboarding appointment.

In addition to using cellular devices and a personalized onboarding appointment, we would also suggest:

• Build Trusted Relationships: Patients are more likely to take regular readings when they have strong relationships with their monitoring team.  We recommend calling patients at least once a week so they feel more connected to their providers and become more invested in improving their own health.
  
  
• Allocate Sufficient Monitoring Staff: Building trusted relationships with patients requires time, so we strongly recommend dedicating clinical staff time to the program so they can focus on providing the best remote care experience for your patients. One full- time clinician who is dedicated solely to RPM can monitor 150-200 patients. If your practice does not have sufficient clinical resources, consider an RPM partner that provides clinical monitoring. Your partner’s clinical team can act as an extension of your own practice and expand your capacity without adding overhead costs. The more your patients interact with their monitoring team, the more likely they are to take more readings.
  
  
• A Good Platform Should Continually Track Patient Adherence: Your RPM platform should make it easy to filter and sort which patients are adhering to their RPM program. After addressing critical and out-of-threshold readings, the monitoring team can use daily workflow to look for patients who are not on track with the prescribed number of readings and should be prioritized for additional outreach.
  
  
• Ask Questions to Understand Non-Adherence:  If patients are not taking regular readings, the monitoring team should try to uncover why. Sometimes the right question can uncover simple reasons why patients are not taking readings. For example, be sure to ask patients if their device is still working, do they truly understand how to use it, does it need new batteries, have they been traveling, or has anything happened in their personal life that is making taking readings more difficult?
  

Most billers use the Install Date or Enrollment Date.

1. Dependency on 99454 and the 16-Day Requirement. Even once you have the patient setup and educated on how to use their device, you cannot bill for 99453 until the patient has taken 16 days of readings within 30 days, which is the requirement for CPT® code 99454. These readings must be 16 separate days, not 16 readings in total. So, if a patient is provided a device but has not yet met the required 16 days of readings within 30 days for CPT® Code 99454, you cannot yet bill for 99453.

Patient setup is the ideal time to establish your expectations for each patient’s engagement and participation in your RPM program. If you simply hand a patient a device or ship it to their home without an onboarding appointment to educate the patient and set expectations, the patient may not comply with the RPM program requirements. 

To maximize patient engagement, we recommend:

1. Cellular Devices are Patient Friendly Devices: To drive higher patient adherence, it’s critical to provide easy-to-use devices for your patients so there are minimal technology barriers. Cellular devices are extremely easy to use and require no setup.  For example, a patient using a cellular blood pressure device only has to push one button to take a reading and transmit the data. In contrast, Bluetooth devices require a smart device, mobile app, and internet connection. Pairing, syncing, and updating apps can be challenging for non-tech-savvy patients. 
   
   
2. Conduct a Personalized Onboarding Appointment: Whether it’s conducted in-person or remotely, a personalized and interactive conversation is critical for engaging patients with RPM. During the RPM appointment, an RPM expert should show the patient how to use the device, coach them through their first reading, explain their RPM treatment plan (frequency and timing of readings), and set expectations for ongoing communication with the monitoring team.
   
   
3. Provide Flexible Onboarding Options: An onboarding event at your office, where your staff has dedicated in-person RPM appointments with new RPM patients, is a great way to engage patients in RPM from Day 1. However, not every patient may be willing or able to attend an in-office visit for RPM. Remote onboarding with direct device shipping can be a great way to boost RPM participation for patients as your RPM program grows.
   
   
4. Start Daily Monitoring Immediately: While the first reading should be taken during the onboarding appointment, you still need the patient to take 15 more days of readings after the onboarding to meet the 99454 16-day requirement, and bill for 99453. Your clinical monitoring team —whether that is your own staff or your RPM partner’s staff —should start engaging with your patients the day after onboarding to encourage daily readings.

Medicare, Medicare Advantage, Texas Medicaid (under the name of "telemonitoring" with different codes than Medicare), and some private payers. For Medicare, RPM is a Part B service.

Use the CMS tool: https://www.cms.gov/apps/physician-fee-schedule/license-agreement.aspx

Not exactly. 99453 is a one-time code. 99454 is an every-30-day code, not to be confused with 99457 and 99458 which are calendar month codes.

• 99453 can only be billed after 16 days of monitoring.
• 99454 should be billed only once each 30 days, regardless of the number of parameters monitored
• Do not report any RPM codes in conjunction with 99091 (legacy remote patient monitoring code)
• RPM can be billed in the same months as CCM, TCM, and BHI (but time spent doing one service, e.g., CCM, can not also count towards time for another service (RPM)).
  Do not count any time on a day when the physician or qualified health care provider reports an evaluation/management service
  Do not count any time related to other reported services (e.g., 93290)
• May be billed as an "incident to" service
  Billing provider must have at least one face-to-face visit with the patient in the preceding 12 months (this rule was relaxed during the COVID-19 PHE to allow for the face-to-face to be done via telemedicine). Face-to-face visits can include levels 2-5 E/M visits, Annual Wellness Visit, Initial Preventive Physical Exams, or the face-to-face from a Transitional Care Management encounter.
• Billing provider must be a Qualified Healthcare Provider (QHCP = MD, DO, NP, PA).

No. If there is a more specific code, you must use the more specific code.

No, you can not round time up.

The ordering provider should document that the patient has given consent for the program. The consent itself can be verbal, but the provider should document that consent was obtained. This is especially important for patients with Original Medicare, because they will be responsible for 20% of the claim that the provider generates (unless their secondary insurance covers it).