2025 CPT code 99454
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Remote Physiologic Monitoring Evaluation and Management > Non-Face-to-Face Services Feed
Supply of remote physiologic monitoring device(s) with daily recording(s) or programmed alert(s) transmission, for each 30-day period.
Modifiers may be applicable depending on the circumstances of service. Consult the CPT manual for appropriate modifier usage.
Medical necessity is established when remote monitoring is deemed appropriate for managing a patient's condition, such as chronic diseases like hypertension, diabetes, or congestive heart failure.The provider must document the clinical rationale supporting the need for RPM and how it contributes to improving the patient's health outcomes.
The provider is responsible for supplying the remote monitoring equipment, educating the patient on its use, receiving the transmitted data, and reviewing it to modify the care plan as needed.This also includes communication with the patient and/or caregiver.
- Evaluation and Management > Non-Face-to-Face Services
- Evaluation and Management > Non-Face-to-Face Services > Remote Physiologic Monitoring
In simple words: This code covers the cost of providing a patient with equipment to track their health at home (like a blood pressure monitor), along with sending the data to the doctor.The doctor needs at least 16 days of readings within a 30-day period to bill for this.
This CPT code reports the supply of FDA-approved remote physiologic monitoring devices to patients, along with the transmission of daily recordings or programmed alerts.The service includes device supply and data transmission for a 30-day period.It requires a minimum of 16 days of data transmission within that 30-day period.The monitored parameters may include weight, blood pressure, pulse oximetry, and respiratory flow rate. This code is not reported if monitoring is less than 16 days or if the services are included in other codes covering the same monitoring period (e.g., continuous glucose monitoring).
Example 1: A patient with hypertension is provided a home blood pressure monitor and instructed to take readings daily. The data is transmitted to the provider's system, and the provider reviews the data and adjusts the medication accordingly., A patient with diabetes is given a glucose monitor and instructed to log their readings. The data is automatically transmitted to the physician, allowing for remote management of the patient's insulin regimen., A patient recovering from a pulmonary embolism is equipped with a pulse oximeter to track their oxygen saturation levels.Daily transmission of data allows for timely intervention if oxygen saturation drops below a critical level.
Documentation should include the order for RPM services, patient education records (if 99453 is also billed), daily or programmed alert transmission records for at least 16 days within the 30-day billing period, provider notes documenting review and interpretation of data, and any modifications made to the care plan.
** The device used must be an FDA-approved medical device. The patient must transmit at least 16 days of readings within a 30-day period.Readings do not need to be consecutive.
- Revenue Code: M5D (Specialist - Other)
- RVU: This information is not provided in the source data.RVUs vary based on geographic location and other factors. Consult the CMS Physician Fee Schedule for current RVU values.
- Global Days: The global period for this code is 30 days. However, a minimum of 16 days of data transmission is required for billing.
- Payment Status: Active
- Modifier TC rule: A Technical Component (TC) modifier does not apply to this code.
- Fee Schedule: Historical fee schedule data is not available in the source data.Consult the CMS Physician Fee Schedule for historical data.
- Specialties:Cardiology, Endocrinology, Pulmonology, Internal Medicine, Family Medicine
- Place of Service:Office, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home