99454 CPT Code
99454 CPT Code
CPT code 99454 covers the supply of remote physiologic monitoring devices given to the patient. It also involves receiving programmed alerts and daily readings from the patient. You can report this code once every 30 days for device supply and physiologic monitoring.
Examples of Reporting CPT Code 99454
COPD Management
A patient with chronic obstructive pulmonary disease (COPD) uses a pulse oximeter and a peak flow meter. They record readings at home and send the data to their healthcare provider daily. The physician can report CPT code 99454 for reimbursement.
Hypertension Management
CPT code 99454 also applies to hypertension management. Regular blood pressure monitoring is vital. Remote patient monitoring (RPM) allows clinicians to assess readings consistently. This data helps adjust treatment plans promptly.
Diabetes Management
For a patient with type 2 diabetes, a blood glucose monitor is provided. This device tracks blood sugar levels in real-time. Timely insights enable the physician to make quick decisions about diet, exercise, and insulin doses. CPT code 99454 is applicable here.
Billing & Coding Guidelines for CPT Code 99454
Provider Eligibility
Only non-physician practitioners (NPPs) and qualified medical professionals can report CPT code 99454.
Patient Eligibility
All RPM-enrolled patients covered by Medicare are eligible for remote care services under this code.
Billing Frequency
Healthcare practitioners must order remote devices every 30 days to code CPT 99454.
Concurrent Billing
Clinicians can bill this code alongside Behavioral Health Integration (BHI), Transitional Care Management (TCM), and Chronic Care Management (CCM) codes.
Data Requirements
Data must be transmitted from a remote device for at least 16 days. This should include codes 99457 and 99458. The data needs to be wirelessly synced for evaluation.
CPT code 99457 covers the first 20 minutes spent by a physician, staff, or qualified healthcare provider monitoring physiological readings. It also includes interactions with the caregiver or patient to adjust the treatment plan based on the data. CPT code 99458 is an add-on for each additional 20 minutes within a 30-day period.
Device Requirements
An RPM-enrolled patient can use multiple devices for remote monitoring under CPT 99454. However, the clinician can bill for these devices only once per patient every 30 days. All devices must meet FDA standards for medical devices.
CPT Code 99454 – Reimbursement Guidelines
Reimbursement Rate
Reimbursement rates for CPT code 99454 can vary. This depends on the patient’s insurance plan and the specific insurance company, such as Medicare, Medicaid, or commercial payers. You may receive up to $47 for reporting this code.
Documentation Requirements
When billing CPT 99454, you must submit detailed documentation with the medical claim. This documentation should include:
Patient’s medical history
Test results
Diagnosis
Clinical notes
Reports of patient education and training on device usage
Physiological data monitoring records for at least 16 days within 30 days
Compliance Requirements
It is essential to stay updated on RPM billing and reimbursement guidelines. Additionally, adhere to HIPAA regulations to avoid legal or financial issues.
