CPT Code 99454 - Remote Patient Monitoring Guide
CPT Code 99454 is the billing code for supplying and monitoring patients with remote patient monitoring devices. The code reimburses providers for the continuous supply of devices and remote patient monitoring. This code can be billed monthly, but only once per patient, per month, regardless of how many devices the patient has. CPT Code 99454 comes with a unique set of rules and qualifications broken down here in this comprehensive guide.
What services are required for CPT Code 99454?
CPT Code 99454 services cover continuous device supply and patient monitoring. This code also covers costs associated with leasing a remote patient monitoring medical device.
Who qualifies for CPT Code 99454?
All remote patients covered by Medicare qualify for CPT Code 99454. The expansion of the remote patient population that came with COVID-19 pandemic, allowed even more Medicare patients to qualify for these CPT codes.
What devices are used for CPT Code 99454?
The major devices used for code 99454 are:
Does CPT Code 99454 cover the device cost?
For billing, CPT Code 99454 covers the monthly servicing costs of devices and treatment services.
How much does Medicare reimburse for 99454?
How to get reimbursed for Remote Patient Monitoring with CPT Code 99454?
Providers can get paid for their Remote Patient Monitoring work by using the right CPT Codes. For CPT Code 99454, monthly billing for supplying devices and monitoring patients, the primary physician or clinician of the patient must order the devices. The primary physician or clinician also needs to provide invoices for the cost of the devices and services related to the devices. CPT Code 99454 requires 16 days of patient data readings during a 30 day billing period.
Can a single patient have multiple RPM devices under CPT 99454?
A single patient can have multiple remote patient monitoringPM devices under the CPT Code 99454, but providers can only bill once per patient per 30 days period, and only when at least 16 days of patient data has been recorded, even when multiple devices are supplied to a single patient.
Do RPM devices have to be FDA certified for CPT 99454?
The Centers for Medicare and Medicaid Services has not stated the specific types of technology or devices that apply to CPT Code 95454 in the most recent CMS-1693-F final rule. The CMS has stated that the device must be a “medical device as defined by the FDA.” Medicare does not require the device to be “approved” or “cleared” by the FDA, but specific providers may require FDA approval for RPM devices.
Who must do the work for each remote patient monitoring service?
The work for each Remote Patient Monitoring service must be ordered by the patient's physician or clinician and they must be monitored for at least 16 days before providers can bill for CPT Code 99454.
How often can CPT Code 99454 be billed?
CPT Code 99454 can be billed every 30 days.
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