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📋 RPM RequirementsTo bill RPM under CPT codes 99453, 99454, 99457, 99458, the following elements must be met:
To bill 99453, 99454, 99457, 99458, the following should be met:
RPM Billing Requirements (Medicare)
Applies to CPT 99453, 99454, 99457, +99458. Paraphrased for education; confirm with current CMS policy.
Use RPM when it’s medically reasonable and necessary for the condition (e.g., hypertension, diabetes, CHF, COPD). Data must be digitally captured and transmitted rather than manually self-reported.
99453 is for the initial onboarding and patient education for the RPM device/service (paraphrased). This work may be furnished by clinical staff or auxiliary personnel under general supervision of the billing practitioner, per CMS rules.
99454 covers the monthly device supply and remote data capture/transmission (paraphrased). Medicare requires at least 16 days of readings within a 30-day period for the device supply period to be billable.
99457 accounts for the first 20 minutes per calendar month of practitioner/clinical staff time managing the patient using RPM data, including required interaction with the patient or caregiver (paraphrased). +99458 is billed for each additional 20 minutes (paraphrased).
For 99457/99458, each month must include at least one real-time, two-way interactive communication with the patient or caregiver (e.g., a live phone call, a telehealth visit, or secure messaging with immediate back-and-forth). One-way device transmissions, automated alerts, or educational materials without a live reply do not satisfy this requirement.
Chart the device type and condition monitored, a summary of data transmissions, the time counted for management, and details of the interactive communication (date, modality, and substance).
Only one practitioner may bill RPM for a patient within a 30-day period. RPM and RTM should not be billed together for the same patient/condition in the same month. Some services may be billed in the same month if time/effort are not double-counted and all other rules are met. CMS also permits general supervision for certain RPM components performed by clinical staff or auxiliary personnel under incident-to rules.
99453 is reported once per initial setup episode. 99454 is billed per 30 days (subject to the 16-day data requirement). 99457 and +99458 are billed monthly based on time (first 20 minutes, then each additional 20 minutes).
✅ Quick Takeaway
RPM enables providers to bill for remote monitoring of physiologic data using FDA‑defined medical devices. To stay compliant:
RPM ensures clinicians are reimbursed for proactive monitoring that supports patient safety and reduces avoidable hospitalizations.
