2025 CPT code 99453
(Active) Effective Date: N/A Revision Date: N/A Evaluation and Management - Remote Physiologic Monitoring Evaluation and Management > Non-Face-to-Face Services Feed
Setup and patient education on the use of remote physiologic monitoring equipment for parameters like weight, blood pressure, and pulse oximetry.
Modifiers may apply in certain scenarios, such as modifier 25 if a significant and separately identifiable E&M service is provided on the same day.Check payer guidelines for specific modifier rules.
Medical necessity is established through the diagnosis and the need for remote monitoring to effectively manage the patient's condition.Documentation should demonstrate the clinical rationale for using remote monitoring and its appropriateness for the patient's situation. For example, remote monitoring may be medically necessary for patients with unstable conditions, those requiring frequent monitoring to prevent complications, or for patients who have limited access to in-person care.
The physician or other qualified healthcare professional is responsible for setting up the remote monitoring equipment, educating the patient on its use, and ensuring the patient understands how to collect and transmit data. This also includes ordering the device and interpreting the data collected.
- 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 initial setup and training a doctor or other qualified health professional gives a patient on how to use a special device to track things like their weight, blood pressure, or oxygen levels from home.It only applies if the monitoring lasts at least 16 days.
This CPT code reports the initial set-up and patient education on the use of remote physiologic monitoring (RPM) equipment.The equipment must be an FDA-approved medical device, and the service must be ordered by a qualified healthcare professional.This code covers instruction on using the device to track parameters such as weight, blood pressure, pulse oximetry, and respiratory flow rate. The service is reported for each episode of care, defined as starting when RPM is initiated and ending upon attainment of treatment goals.The code is not reported if monitoring is less than 16 days or if the services are included in other codes (e.g., 95250 for continuous glucose monitoring).
Example 1: A cardiologist sets up a patient with remote blood pressure monitoring to track hypertension management after discharge from the hospital. The patient is instructed on how to use the device and transmit data. Code 99453 is billed for the setup and education.Monitoring continues for 20 days, successfully reducing the patient's blood pressure and enabling modification of medication., A pulmonologist sets up a patient with remote pulse oximetry monitoring to track oxygen saturation levels post-pneumonia.The patient receives training on how to use the device and transmit readings.Code 99453 is billed for the setup and education. Monitoring continues for 25 days, documenting improvement in the patient's oxygen levels and enabling timely adjustment of treatment., A diabetes educator sets up a patient with remote glucose monitoring to track blood glucose levels and improve diabetes management.The patient is trained on how to use the device and transmit readings. Code 99453 is billed for the setup and education.The patient's diabetes is well-managed for the next 30 days.
* Documentation of the type of remote physiologic monitoring equipment used (including FDA approval).* Documentation of the date the equipment was set up and the date of patient education.* Detailed instructions given to the patient on how to use the equipment, including frequency of monitoring and data transmission procedures.* Documentation of the parameters being monitored (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate).* Confirmation that the equipment used meets FDA requirements for medical devices.* A record of all communication with the patient during the monitoring period, including any modifications to care plans based on monitoring data.
** Ensure that all documentation supports the medical necessity of the service.Incomplete or inaccurate documentation can lead to claim denials.Always verify payer-specific guidelines and requirements before billing.
- Revenue Code: M5D (SPECIALIST - OTHER)
- RVU: Refer to the CMS Physician Fee Schedule for current Relative Value Units (RVUs) and payment rates.These values vary by location and payer.
- Global Days: This code is not part of a global surgical package.
- Payment Status: Active
- Modifier TC rule: Not applicable.This is a professional service code.
- Fee Schedule: Historical fee schedule data is available through the CMS Physician Fee Schedule database.Note that fee schedules change regularly.
- Specialties:Cardiology, Pulmonology, Endocrinology, and other specialties where remote physiologic monitoring is clinically indicated.
- Place of Service:Office, Home, Telehealth Provided in Patient’s Home, Telehealth Provided Other than in Patient’s Home