CPT Code 99458
CPT Code 99458
CPT code 99458 is an add-on code for RPM billing. It allows providers to receive reimbursement for each additional 20-minute increment of remote patient monitoring. This is beyond the first 20 minutes covered by CPT 99457. The code ensures healthcare professionals are compensated for extra time spent on patient data management, clinical decisions, and communication.
Key Details of CPT Code 99458
Purpose: Covers each additional 20 minutes of RPM care management and communication beyond the initial 20 minutes of CPT 99457.
Reimbursement (2025): Approximately $38.49 (Medicare non-facility rate).
Billing Frequency: Up to two times per month.
Who Can Bill for CPT 99458?
Eligible healthcare professionals for billing CPT 99458 include:
Physicians
Advanced Practice Registered Nurses (APRNs)
Clinical staff supervised by a qualified healthcare professional
Billing Requirements for CPT 99458
To qualify for reimbursement under CPT 99458, the following conditions must be satisfied:
The patient must be enrolled in a Remote Patient Monitoring (RPM) program.
Only one provider can bill for RPM services for a single patient each month.
The provider or clinical staff must spend a minimum of 21 minutes each month managing patient data and communicating interactively.
CPT 99458 can only be billed after CPT 99457 has been billed for the initial 20 minutes of RPM management.
Billing Frequency for CPT 99458
Practices may bill CPT 99458 up to twice a month, in addition to one unit of CPT 99457. For instance, if a practice logs between 40 and 60 minutes of patient engagement in a month, it should file a claim for CPT 99457 along with two units of CPT 99458—one for the time between 20 and 40 minutes, and another for the time between 40 and 60 minutes. If the total exceeds 60 minutes, no additional billing of CPT 99458 is allowed. The claim should include CPT 99457 and two units of CPT 99458.
Best Practices for Billing CPT 99458
To ensure proper reimbursement and compliance, follow these best practices:
Track RPM Time Accurately: Keep detailed records of time spent on patient data and communication.
Bill After CPT 99457: Only bill for 99458 after accounting for at least 20 minutes under 99457.
Set Patient Expectations: Inform patients about the need for regular communication and data transmission, emphasizing the requirement for live interactions each month.
