Remote Patient Monitoring (RPM) allows healthcare providers to track patients’ health data remotely, improving the management of chronic conditions. One important element of this system is CPT code 99458, which enables providers to bill for the remote management of treatment for at least 20 minutes.
Understanding CPT 99458 is vital for healthcare professionals, as it ensures accurate billing and helps improve patient care. By using this code, providers can deliver effective treatment while increasing their revenue through proper reimbursement.
In this blog, you’ll learn all about CPT 99458, its eligibility requirements, and how it works. Healthcare providers should read on to learn how this code can streamline billing, maximize reimbursement, and ultimately support better patient outcomes.
Table of Contents
What is RPM CPT Code 99458?
99458 CPT code description
CPT code 99458 is an add-on code used in Remote Patient Monitoring (RPM) billing. It allows healthcare providers to be reimbursed for each additional 20-minute increment of time spent managing a patient’s care remotely beyond the initial 20 minutes covered under CPT 99457.
Purpose: CPT 99458 is designed for providers to be reimbursed for the additional time spent monitoring patient data, making clinical decisions, and engaging in interactive communication with the patient or caregiver. This code ensures that healthcare professionals are compensated for time beyond the initial 20 minutes covered by CPT 99457.
What is the difference between CPT Code 99457 and 99458?
CPT 99457 and CPT 99458 are both used for Remote Patient Monitoring (RPM) but differ in terms of time requirements and scope. CPT 99457 covers the first 20 minutes of RPM management, including interactive communication with the patient.
CPT 99458 is an add-on code for additional 20-minute increments beyond the initial 20 minutes of CPT 99457. 99457 code is billed for the first 20 minutes of care. CPT 99458 can be billed up to twice per month, for a total of 40 minutes of additional care management.
Source: Remote Patient Monitoring Billing, Coding and Regulations Information
How many times can 99458 CPT Code be billed in a calendar month?
Providers can bill CPT 99458 up to twice per month, which means they can receive reimbursement for up to 60 minutes of care for each patient per month. This is ideal for patients who require ongoing monitoring and adjustment of their care plan.
For example, if a provider spends 40 minutes managing a patient’s health remotely, they can bill for CPT 99457 (first 20 minutes) and two units of CPT 99458 (second 20 and third 20 minutes). For 60 minutes or more, no additional 99458 billing is allowed beyond two units.
Billing Requirements for CPT Code 99458
To ensure proper reimbursement for 99458 CPT code, the following criteria must be met:
- Patient Enrollment: The patient must be enrolled in an RPM program and using approved remote monitoring devices.
- Time Requirement: The provider must spend at least 20 minutes per month managing patient data and engaging in interactive communication (after billing CPT 99457 for the first 20 minutes).
- Billing Frequency: CPT 99458 can be billed up to twice per month for additional increments of 20 minutes each.
- Single Provider Billing: Only one provider may bill for RPM services per patient per month.
- Compliance: Ensure all documentation of time spent on care management and communication is accurate and complete.
Reimbursement for CPT Code 99458
Reimbursement for CPT code 99458 depends on several factors, including payer policies, patient condition, and geographic location. Here’s what you need to know:
Medicare Reimbursement
CPT 99458 is reimbursed at approximately $38.49 under the Medicare Physician Fee Schedule for 2025. This rate can vary based on location and Geographic Practice Cost Index (GPCI).
Private Insurers
Reimbursement rates for CPT 99458 can vary widely among private insurers. Some may follow Medicare guidelines, while others may have different rates or billing policies.
Providers should check with individual payers to understand the specific reimbursement policies and billing limits for CPT 99458.
Documentation for Reimbursement
Accurate documentation is critical for proper reimbursement. Providers must track the time spent on data review, care adjustments, and patient communication.
Ensure all RPM activities are documented in the patient’s electronic health record (EHR), and include details on the time spent and the adjustments made to the treatment plan.
By ensuring proper documentation and following billing guidelines, healthcare providers can ensure they are reimbursed correctly for 99458 CPT code and maintain compliance with payer policies.
Conclusion
CPT code 99458 plays a vital role in ensuring that healthcare providers are properly reimbursed for the time they spend managing remote patient care beyond the initial 20 minutes covered under CPT 99457.
By understanding and using this add-on code effectively, providers can ensure they’re maximizing reimbursement while improving patient care through continuous monitoring and proactive treatment adjustments.
Ready to optimize your remote patient monitoring process? Visit CandiHealth to streamline your billing, improve patient outcomes, and ensure compliance with the latest RPM guidelines.
Frequently Asked Questions (FAQs)
Can CPT code 99457 and 99458 be billed together?
Yes, CPT 99457 can be billed first for the initial 20 minutes, and CPT 99458 can be billed for additional 20-minute increments of care, up to twice per month.
What is the difference between CPT code 99453 and 99454?
CPT 99453 covers the initial setup and patient education for RPM, while CPT 99454 is for monthly supply and data transmission for up to 16 days.
Who can bill 99458?
Physicians, Advanced Practice Registered Nurses (APRNs), and clinical staff under the supervision of a qualified healthcare provider can bill CPT 99458.
What is the limit for 99458?
CPT 99458 can be billed up to twice per month, allowing a total of 40 minutes of additional care management.
