2025 CPT code 99091
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Non-Face-to-Face Services Evaluation and Management Feed
Collection and interpretation of digitally stored and/or transmitted patient data (e.g., ECG, blood pressure, glucose monitoring) requiring at least 30 minutes of provider time, per 30-day period.
Modifiers may be applied as clinically indicated.
Medical necessity is established by the need for the physician to review the patient's home-monitored physiologic data to adjust treatment, ensure patient safety, or prevent complications.Chronic conditions or unstable conditions that require frequent monitoring can support medical necessity.
The provider reviews and interprets electronic physiologic data from the patient, spending a minimum of 30 minutes per 30-day period. This includes modifying the care plan based on data review and communicating with the patient and/or caregiver.
In simple words: Your doctor reviews your health data (like blood pressure or heart rhythm readings) that you sent electronically.If this review takes at least 30 minutes over a month, your doctor might bill for this service.
This CPT code, 99091, reports the physician's or other qualified healthcare professional's time spent collecting, reviewing, and interpreting patient-generated physiologic data (such as electrocardiograms (ECGs), blood pressure readings, or glucose monitoring results) transmitted electronically.The service requires a minimum of 30 minutes of provider time for each 30-day period.This code is not reported if the services are included in other codes, performed on the same day as an E/M service, or if more specific codes exist for the data being reviewed. It should not be reported in conjunction with codes for care plan oversight, remote physiologic monitoring (99457, 99458), or chronic care management services.
Example 1: A patient with hypertension uses a home blood pressure monitor and transmits the readings to their physician. The physician reviews the data, interprets the results, adjusts medications if needed, and communicates these changes to the patient, spending 45 minutes on this process during the 30-day period., A diabetic patient uses a continuous glucose monitor and shares the data with their endocrinologist. The endocrinologist reviews the data over several days, spending a total of 35 minutes interpreting the glucose readings and making adjustments to the patient's insulin regimen and diet., A patient recovering from a heart attack uses a home ECG monitor and transmits the readings to their cardiologist. The cardiologist reviews the ECGs for arrhythmias, spending 30 minutes on the review and communicating with the patient and their family.The data interpretation and communication are billed with this code.
Documentation should include the date(s) and time spent reviewing the data, the type of physiologic data reviewed (e.g., ECG, blood pressure, glucose readings), the interpretation of the data, any modifications to the care plan, and any communication with the patient or caregiver.The minimum time spent (30 minutes) must be documented.Evidence of electronic data transmission should also be included.
** Most carriers consider this code unpayable under the Provider Fee Schedule; however some private payers may allow reimbursement.The services are often considered part of the pre- and post-service work associated with E/M services.
- Revenue Code: M5D (SPECIALIST - OTHER)
- Payment Status: Active
- Specialties:Cardiology, Endocrinology, Internal Medicine, Family Medicine
- Place of Service:Office, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home