What is CPT Code 99453?

CPT Code 99453 is a medical billing code associated with Remote Patient Monitoring (RPM) services. It specifically pertains to the initial setup and education of patients regarding remote monitoring devices. This includes instructing patients on how to operate the device and ensuring they can successfully send data to their healthcare providers.

Key Details of CPT Code 99453

·        Purpose: Covers the installation and onboarding process for a remote physiologic monitoring device.

·        Reimbursement (2025): $19.73 (National Medicare non-facility rate).

·        Billing Limitations: Can be billed only once per patient during each episode of care.

Who Can Bill for CPT Code 99453?

CPT Code 99453 can only be billed by qualified healthcare professionals, such as physicians, nurse practitioners, or physician assistants, who are authorized to bill for evaluation and management (E/M) services. Eligible providers include:

·        Physicians

·        Advanced Practice Registered Nurses (APRNs)

·        Clinical staff working under the general supervision of a physician or qualified health professional (QHP)

Billing Requirements 

To bill for CPT 99453, the following criteria must be met:

·        The device must comply with the FDA's definition of a medical device.

·        The patient must provide consent to participate in a Remote Patient Monitoring (RPM) program (patient consent form)

·        Only one provider may submit a claim for CPT 99453 per patient during each episode of care.

·        CPT 99453 may be billed alongside other RPM codes (e.g., 99454, 99457), but only once for each device setup.

When Can CPT Code 99453 Be Billed?

CPT 99453 can be billed only once per patient at the start of a monitoring program, irrespective of how many devices are set up. The provider can submit the claim after successfully completing the device setup and training for the patient.

·        If a patient is provided with multiple RPM devices (such as a blood pressure monitor and a weight scale), only one claim can be submitted.

·        CPT 99453 should be billed in the first month when the patient has submitted 16 days' worth of device readings (fulfilling the criteria for CPT 99454).

·        Rebilling for CPT 99453 is not allowed unless the patient enters a new episode of care that necessitates a new device setup and training.

What Devices Qualify for CPT 99453?

As Remote Patient Monitoring (RPM) has grown, so has the variety

of devices available. However, not all devices that gather patient data qualify

for billing under CPT 99453. To be eligible, a device must:

·        Comply with FDA regulations.

·        Transmit data wirelessly in real time.

·        Ensure that physiologic data is electronically collected and securely uploaded for analysis by the billing practitioner.

Common RPM Devices That Qualify:

·        Blood Pressure Monitors: Used for monitoring hypertension and cardiovascular health.

·        Weight Scales: Helpful for managing conditions like congestive heart failure (CHF) and obesity.

·        Pulse Oximeters: Measure oxygen saturation (SpO2) levels, crucial for chronic respiratory disease management.

·        Blood Glucose Monitors: Essential for tracking blood sugar levels in diabetes management.

Healthcare providers must ensure that selected RPM devices meet

the FDA's definition of a medical device and support secure data transmission.

This not only facilitates proper reimbursement but also enhances patient care.

 CPT 99453 vs. Other RPM Codes

CPT code 99453 covers the initial setup and patient education for RPM, ensuring effective device use. It's important for compliance and reimbursement but is just one of several CPT codes used in RPM billing.  

Best Practices for Billing CPT 99453

To ensure proper reimbursement for CPT 99453, follow these best

practices:

·        Confirm Patient Eligibility: Verify coverage under Medicare or private payers.

·        Document Training Sessions: Record details such as date, time, and content covered.

·        Ensure Device Compliance: Confirm that devices meet FDA medical device requirements.

·        Bill Once Per Patient: Submit claims only once per patient per care episode.

·        Use Correct Coding Combinations: Pair CPT 99453 with codes like CPT 99454 for ongoing monitoring.

Importance of CPT 99453

CPT code 99453 is crucial for remote patient monitoring (RPM)

billing, covering initial setup and patient education. Adhering to CMS

guidelines and properly documenting training can enhance patient engagement,

improve health outcomes, and increase practice revenue through RPM services.