2025 CPT code 99457
(Active) Effective Date: N/A Evaluation and Management - Non-Face-to-Face Services Feed
Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.
Modifiers may be applicable. Refer to current CPT guidelines for specific modifier usage.
Medical necessity for this code must be supported by documentation demonstrating the patient's clinical need for remote physiologic monitoring and how it contributes to the management of their condition.The chosen treatment plan and the reasons for adjustments based on remote monitoring data should also be documented.
The provider (clinical staff, physician, or other qualified healthcare professional) evaluates recordings from remote monitoring equipment to track and adjust the patient's management based on the recordings. The provider communicates interactively with the patient or caregiver to adjust treatment as needed.
In simple words: The provider monitors a patient's remote physiologic recordings and/or programmed alerts and interacts with the patient or caregiver to adjust treatment based on the recordings. This code represents the first 20 minutes of provider time spent on this service in a calendar month.
This code covers the first 20 minutes of clinical staff/physician/other qualified healthcare professional time in a calendar month spent on remote physiologic monitoring treatment management services.These services require interactive communication with the patient/caregiver during the month. The service involves the use of a medical device as defined by the FDA, ordered by a physician or other qualified health care professional, to monitor physiological parameters (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate) and manage the patient under a specific treatment plan.It is billable once per month and may be used alongside chronic care management (CCM), principal care management (PCM), transitional care management (TCM), and behavioral health integration (BHI) services, but time cannot be counted toward both services.
Example 1: A patient with hypertension has their blood pressure monitored remotely. The provider reviews the data and communicates with the patient to adjust their medication dosage based on the readings., A patient with heart failure has their weight and oxygen saturation levels monitored remotely. The provider reviews the data and contacts the patient to discuss potential fluid buildup or other concerns., A patient with diabetes has their blood glucose levels monitored remotely.The provider reviews the data and adjusts the patient's insulin regimen accordingly, communicating the changes to the patient.
Documentation should include the date and time of the remote monitoring, the physiological parameters monitored, the results of the monitoring, the communication with the patient/caregiver, and any changes to the treatment plan.The medical device used should be documented, along with the physician's order for the service. The total time spent on remote physiologic monitoring should be clearly documented, as should the interactive communication with the patient/caregiver.
** It's important to accurately document the total time spent providing remote physiologic monitoring services, as well as the time spent in interactive communication with the patient/caregiver. Ensure all devices used meet FDA guidelines for medical devices. Time spent on other billable services cannot be counted towards the 20 minutes required for 99457.
- Revenue Code: M5D - SPECIALIST - OTHER
- RVU: 0.61 (Work RVU)
- Payment Status: Active
- Modifier TC rule: Not applicable
- Specialties:Cardiology, Endocrinology, Pulmonology, Primary Care, and other specialties managing chronic conditions.
- Place of Service:Office, Home, Outpatient Hospital, and other places where remote monitoring services are provided.