CPT Code 99457
CPT Code 99457
CPT code 99457 pertains to RPM treatment management services. It covers a minimum of 20 minutes of time spent by clinical staff, physicians, or qualified healthcare professionals in a month. This includes interactive communication with patients or caregivers. The code reimburses providers for monitoring patient data and making treatment adjustments. Its goal is to enhance patient health outcomes.
Key Aspects of CPT Code 99457
Purpose: Covers 20 to 40 minutes per month of RPM and interactive communication with patients or caregivers.
Reimbursement (2025): Average rate is about $48.14, varying by location and payer contracts.
Billing Frequency: Billable once per calendar month for each patient receiving remote patient monitoring services.
Who Can Bill for CPT 99457?
Eligible healthcare professionals include:
Physicians
Advanced practice registered nurses (APRNs)
Clinical staff under the supervision of a qualified healthcare professional
Supervision requirements vary by state and payer, so review specific guidelines before billing.
CPT 99457 Eligibility and Billing Requirements
To bill for CPT 99457, providers need to fulfill certain criteria:
Interactive Communication: There must be at least one real-time interaction with the patient or caregiver each month. Acceptable forms include phone or video calls; however, text messages and voicemails do not qualify.
Time Documentation: Providers must document a minimum of 20 minutes spent on activities such as reviewing patient health data, communicating with patients, coordinating care, and adjusting treatment plans. Detailed records are crucial for compliance and reimbursement.
Qualified Providers: Services must be delivered by a physician, qualified healthcare professional, or clinical staff under the general supervision of the billing provider.
Best Practices for RPM and CPT 99457
To ensure compliance and reimbursement for RPM, consider these best practices:
Set Clear Patient Expectations: Inform patients during onboarding about the need for regular communication and monthly live interactions as per CPT 99457.
Utilize Time-Tracking Tools: Use RPM platforms with automated time tracking to simplify accurate documentation of time spent on monitoring.
Optimize Staffing Models: Depending on patient volume, assign dedicated staff to RPM services or collaborate with third-party monitoring companies for efficient management.
Engage Patients Meaningfully: Foster strong patient-provider relationships through personalized outreach and education to enhance engagement and compliance in RPM programs.
