What is CPT Code 99454? Remote Physiologic Monitoring

CPT Code 99454 is one of four Remote Physiologic Monitoring codes that were introduced by CMS for Calendar Year 2019.

CPT Code 99454 reimburses providers $69 per patient per month for – “Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s)or programmed alert(s) transmission, every 30 days.”

$69 per patient per month and is paid when a practice can demonstrate that a patient has electronically submitted one or more vital statistics on at least 16 calendar days in a month

It reimburses $69 per patient per month and is paid when a practice can demonstrate that a patient has electronically submitted one or more vital statistics on at least 16 calendar days in a month.  It is labeled a PE Code or “Practice Expense Code” and requires zero activity from a physician and has no associated RVUs.  It is this code that all the device companies are calling you about.

The RPM codes that your practice should be most interested in are the time-based RPM codes.  They pay 30% more than CCM and do not require connected devices.  RPM CPT Codes of 99457 (initial – $54) and 99458 (subsequent – $42)  are both monthly recurring RPM codes and carry .61 RVU.  Similar to CCM both of these codes depend upon 20 minute increments of non-face-to-face care management activities and no distinction is made between which types of activities qualify as CCM and which qualify as RPM.  They are the same.  However, to upgrade CCM time to RPM time you must be able to document that in addition to the 20 minutes of time, your practice has had at least one live interactive  (phone or video call) and the patient has self-reported at least one vital statistic during the calendar month.  You may stack both CCM and RPM codes together so long as no time is double counted.

Blood pressure to inform hypertension treatment and blood glucose to inform diabetes management are the two most utilized vitals in RPM nationwide.  Weight and heart rate round out prominent cardiac monitoring along with pulse ox for pulmonology.

Practices do not require expensive and specialty ‘connected devices’ to be able to bill for RPM, CPT 99454.  Guidelines require that the patient utilize an FDA approved device (any off the shelf blood pressure cuff or glucometer for example) and electronically submit those results.