📋 RPM RequirementsTo bill RPM under CPT codes 99453, 99454, 99457, 99458, the following elements must be met:

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1) Patient Eligibility (CMS)

• Patient must have a condition where monitoring physiologic data is medically necessary (e.g., hypertension, diabetes, CHF, COPD).
• Data must be digitally uploaded and transmitted, not self‑reported manually.

2) Device & Setup (CMS/AMA)

• 99453: Initial setup and patient education on use of RPM device.

“Remote monitoring of physiologic parameter(s)… initial set-up and patient education.” (AMA CPT® descriptor)

3) Device Supply (CMS)

• 99454: Device(s) supply with daily recordings and programmed alerts, billed per 30 days.

“Device supply with daily recordings or programmed alerts transmission, each 30 days.” (AMA CPT® descriptor)

• CMS requires 16 days of data in a 30‑day period for billing 99454.

“At least 16 days of data in a 30‑day period are required to bill 99454.” (CMS, 2021 PFS Final Rule)

4) Treatment Management (CMS/AMA)

• 99457: First 20 minutes of clinical staff/physician/QHP time in a calendar month, spent on management and interactive communication with the patient/caregiver.
• +99458: Each additional 20 minutes.

“Treatment management services… requiring interactive communication with the patient or caregiver during the calendar month.” (AMA CPT® descriptor)

5) Communication Requirement (CMS/AMA)

• Interactive communication is explicitly required for 99457/99458.

“Treatment management services… requiring interactive communication with the patient or caregiver during the calendar month.” (AMA CPT® descriptor)

• CMS reinforces this requirement:

“Codes 99457 and 99458 include time spent in treatment management services and require at least one synchronous, two-way interactive communication with the patient or caregiver each month.” (CMS, CY 2019 PFS Final Rule)

• What counts: live phone calls, telehealth visits, or secure portal/chat with real-time back‑and‑forth.
• What does not count: one‑way data transmission, automated alerts, or educational materials without response.

6) Documentation (CMS)

• Document device type, condition monitored, patient education/setup, data transmission logs, time spent, and details of interactive communication.

7) Billing Restrictions (CMS)

• Only one practitioner may bill RPM for a patient per month.
• RPM cannot be billed concurrently with RTM for the same patient/condition in the same month.
• Clinical staff time may be billed under general supervision.

8) Frequency

• Device supply code (99454) is billed per 30 days.
• Management codes (99457/99458) are billed monthly.

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