CPT-99454

CPT code 99454 Introduction

The monthly service starts after the patient enrolls in the RPM program. The medical device(s) for health data and alert transmissions are reported using this service code, which is reimbursed under CPT Code 99454.

CODE DESCRIPTION

CPT 99454 is used for monthly remote monitoring of physiological parameters and covers the supply of equipment used by patients to monitor and record physiological data.

This includes the provision and use of medical devices used for remote monitoring and collection of patient-generated health data (PGHD). Specifically, this means data transfer and does not include time spent training and setting up how to use the device.

RPM Devices

Following are the FDA approved devices used for code 99454:

• Blood Pressure Cuff
• Pulse Oximeter
• Blood Glucose Monitor
• Digital Weight Scale

CODING CRITERIA

• For CPT 99454, providers must order the devices in order to code it monthly.
• All remote patients covered by Medicare are eligible for CPT code 99454.
• The expansion of the remote patient population associated with the COVID-19 pandemic has allowed even more Medicare patients to qualify for this CPT code.
• Only medical professionals and NPPs qualified to provide E/M services may bill RPM services.
• Providers may use this code during the same service period as Chronic Care Management (CCM) (99487-99490), Transitional Care Management (TCM) (99495-99496), and Behavioral Health Integration (BHI) (99484, 99492-99494).

BILLING CRITERIA

• CPT 99454 requires the transfer of data from a remote device for at least 16 days along with CPT 99457 (for first 20 minutes) and CPT 99458 (for each additional 20 minutes upto 80 mins) within a 30-day period.
• For Covid-19 users, however, only two days of monitoring are necessary while the public health emergency (PHE) is still in effect.
• For billing, CPT Code 99454 covers the monthly servicing costs of devices and treatment services.
• A single patient can have multiple PM devices for remote patient monitoring under CPT code 99454, but providers can only claim once per patient in a 30-day period.
• Devices used must meet the FDA definition of a medical device.
• Data should be synced wirelessly where it can be evaluated.

REIMBURSEMENT CRITERIA

CPT code 99454 permits for a reimbursement of $55.72 for technology offered under this code, regardless of device cost.