CPT-99457

CPT code 99457 Introduction

CPT 99457 is used as the follow-up of the previous two RPM codes (CPT 99453 & 99454). After the process is initiated and a certain amount of data has been collected, CPT code 99457 covers the first time a physician or qualified clinician spends actually treating a patient’s condition. These, like collected data, can also be managed remotely, such as by phone or video connection.

CODE DESCRIPTION

CPT Code 99457 is developed to provide reimbursement for care coordination and physician-patient interactions. This code is used to report treatment management of patients currently remotely monitored for physiological parameters. Regardless of the number of modalities performed, the provider can report CPT 99457 once in a calendar month when providing at least 20 minutes of live interactive communication.

CODING CRITERIA

• For CPT 99457, at least 20 minutes of clinical time must be recorded each month.
• Once CPT 99457 has been billed, an add on code 99458 can be used for time more than 20 minutes.
• 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

• This code is billed once a month regardless of the RPM patient’s status.
• Devices used must meet the FDA definition of a medical device.
• Data should be synced wirelessly where it can be evaluated.

REIMBURSEMENT CRITERIA

On average CPT code 99457 permits for a reimbursement of $50.18.