2025 CPT code 99458
(Active) Effective Date: N/A Evaluation and Management - Non-Face-to-Face Services Feed
Remote physiologic monitoring treatment management services, each additional 20 minutes of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver (List separately in addition to code for primary procedure).
Modifiers may be applicable to 99458 in certain circumstances. For example, modifier 25 might be used if a significant, separately identifiable E/M service is provided by the same physician on the same day.
Medical necessity must be established for remote physiologic monitoring. This involves documenting the clinical rationale for monitoring specific physiologic parameters remotely, the patient's condition and complexity of their illness, and the plan of care aligned with treatment goals. Payer-specific guidelines should be followed.
The provider evaluates recordings from remote monitoring equipment to track and report physiologic parameters such as weight, blood pressure, blood oxygen levels, and expiratory flow rate. The provider communicates with the patient or caregiver to adjust the patient’s management based on the patient’s reports. The provider can be clinical staff, a physician, or other qualified healthcare provider, and this code represents each additional 20 minutes of the provider’s time.
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 is used for each additional 20 minutes (after the first 20 minutes reported with 99457) of clinical staff, physician, or other qualified healthcare provider time spent providing this service.
This code is used for remote physiologic monitoring treatment management services provided by clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the month, for each additional 20 minutes.It is used in conjunction with 99457 (first 20 minutes).It is not reported for services of less than an additional increment of 20 minutes.For remote therapeutic monitoring treatment management services, use 98980, 98981.
Example 1: A patient with hypertension has their blood pressure monitored remotely.After the initial 20 minutes of remote monitoring in a calendar month are reported with 99457, an additional 40 minutes are spent by clinical staff adjusting medications and providing education based on the readings.99458 would be reported twice., A patient with diabetes has their blood glucose levels monitored remotely. Following the initial setup and 20 minutes of monitoring reported using code 99457, the physician spends an additional 20 minutes communicating with the patient and adjusting insulin dosages based on the data. Code 99458 is reported once., A patient with heart failure uses a remote monitoring device to track their weight, blood pressure, and oxygen saturation. After the initial 20 minutes of remote monitoring and patient interaction covered by 99457, the healthcare provider dedicates an extra hour (60 minutes) in the same month to remotely evaluate the collected data, communicate with the patient about medication adjustments, and coordinate care with the patient's cardiologist. Code 99458 would be reported three times to account for the additional time spent beyond the initial 20 minutes.
Documentation should include the total time spent on remote physiologic monitoring treatment management services (excluding time counted towards other services), the date of the service, the types of physiologic data being monitored, the patient's response to treatment adjustments, and details of the interactive communication with the patient/caregiver.
** Time spent performing remote physiologic monitoring should not be counted towards the time required for other services provided in a single month.A live, interactive communication with the patient or caregiver is required, but it does not need to encompass the entire cumulative reported time.
- Payment Status: Active
- Specialties:Specialties that commonly use 99458 include cardiology, pulmonology, endocrinology, and primary care.
- Place of Service:Office, Home, Inpatient Hospital, etc.