CPT Code 99454

The Top Things You Need to Know to Bill CPT® Code 99454

CPT® code 99454 covers the automated data transmission from the patient’s device to the practice’s Remote Physiologic Monitoring (RPM) platform.
The code requires that patients take a minimum number of readings per month to be eligible for reimbursement.

Here are the most important things you need to know before billing CPT® Code 99454.

Who can order 99454?
An ordering provider (a physician or other qualified healthcare provider) can order RPM for the patient.
Note: while the patient does not need to have an official diagnosis, the ordering provider should only prescribe an RPM program to a patient if they believe the prescription is medically necessary.
Common conditions are monitored via RPM include: hypertension, diabetes, chronic kidney disease, and chronic/congestive heart failure.

The 16-Day Requirement.
To bill 99454, the patient must submit at least 16 days of readings within 30 days.
These readings must be taken on separate days, so if a patient takes readings twice a day for 10 days, that would only count as 10 days of readings.
The reading days do not need to be consecutive, but patients are more likely to be successful if they take their readings each day.

Billable Every 30-Days.
99454 can be billed once every 30 days.
It’s not tied to the calendar month, though many practices choose to bill on a calendar basis to simplify billing.

Patients with Multiple Devices: If a patient has multiple devices, the total days of readings still must be 16.
However, readings from both devices will count toward the 16-day requirement.
For example, if a patient takes a blood pressure and weight reading on the same day, that would count as one day of readings.

Reimbursement Rates. According to the CMS CPT© Guidebook, Professional Edition 2023, the national average reimbursement rate will vary by geography and location.
Local reimbursements can be located at CMS.gov physician fee schedule.