CPT Code 99454 is one of the most frequently used codes in Remote Patient Monitoring, and one of the most commonly misbilled. It reimburses providers for supplying FDA-approved devices and collecting physiological data from patients every 30 days.
As RPM becomes more widely adopted across specialties, it’s also drawing closer attention from payers. Inconsistent usage or incomplete documentation can result in denied claims, delayed payments, or compliance reviews.
That’s why understanding how to bill CPT Code 99454 correctly is important. This guide gives you a clear breakdown of what 99454 covers, how to bill it compliantly, and what to avoid. If your practice offers RPM, this is a code you can’t afford to misunderstand.
Table of Contents
What is CPT Code 99454?
CPT Code 99454 is used to bill for the provision of remote patient monitoring (RPM) devices and the collection and transmission of health data. The code applies when a healthcare provider supplies an FDA-defined medical device to a patient, and that device automatically records and transmits physiological data over a 30-day period.
This code does not cover clinical interpretation or direct patient interaction. It strictly reimburses for:
- Supplying the device(s)
- Enabling data capture
- Transmitting readings to the provider
This code is typically billed alongside other RPM codes such as 99453 (device setup) and 99457 (clinical monitoring), but 99454 focuses solely on the technical service of device supply and data transmission.
What’s Included in CPT 99454?
CPT Code 99454 covers three core components tied to Remote Patient Monitoring services:
1. Device Supply
The provider supplies an FDA-defined medical device to the patient. The device must be capable of collecting and transmitting physiologic data relevant to a diagnosed condition, such as blood pressure, glucose, oxygen saturation, or weight.
2. Automated Data Capture
The device must automatically record data without requiring the patient to manually input readings. CMS specifically excludes devices that rely on self-reporting or manual data entry, including app-based trackers and questionnaires.
3. Data Transmission
The recorded data must be electronically transmitted to the healthcare provider or monitoring team. This transfer must be secure, continuous, and capable of supporting clinical decision-making.
Covered device types commonly include:
- Blood pressure monitors
- Glucometers
- Pulse oximeters
- Digital weight scales
- ECG monitors
CPT Code 99454 Billing Requirements and Rules
Billing CPT Code 99454 requires strict adherence to CMS guidelines. Failure to meet any of the following criteria may result in denied claims or compliance issues.
1. The device must be FDA-defined
Only FDA-cleared or approved medical devices qualify. The device must be capable of automatically collecting and transmitting physiological data. Non-medical wellness devices, fitness trackers, or manual-entry apps are not eligible.
2. Data must be captured for 16 days within 30 days
You can bill 99454 once per patient every 30 days, but only if the device collects and transmits readings on at least 16 unique days during that period. Data must be digitally stored and automatically transmitted. If the patient doesn’t meet the 16-day threshold, billing for that month is not permitted.
3. Only one provider can bill per 30-day cycle
CMS allows only one billing provider to submit 99454 for a patient per 30-day period, even if multiple providers are involved in the patient’s care.
4. Patient consent is required
You must document the patient’s verbal or written consent before initiating RPM services. This is a compliance requirement and must be available in case of audit.
Note: Billing frequency is not impacted by calendar month (e.g., billing can span from the 10th of one month to the 9th of the next).
Staying compliant with these rules ensures full reimbursement and minimizes audit risk. Providers should review their RPM processes regularly to verify that all criteria are being met consistently.
How much is CPT 99454 reimbursement?
CPT Code 99454 is reimbursed by Medicare as a monthly recurring code, provided all billing conditions are met. As of the most recent CMS Physician Fee Schedule, the national average Medicare reimbursement rate for CPT Code 99453 is $43.02 per patient per month.
Note: The exact amount varies by region and payer-specific fee schedules.
99454 vs. 99453 vs. 99457: What’s the Difference?
Remote Patient Monitoring (RPM) involves multiple services, each covered by a specific CPT code. Understanding how CPT Code 99454 fits into the full billing framework is important for proper documentation and reimbursement.
Below is a side-by-side comparison of the most frequently used RPM codes:
| CPT Code | Description | Reimbursement Amount | Billing Frequency |
| 99453 | Initial setup and patient education | $19.73 | One-time per patient |
| 99454 | Monthly remote monitoring with daily recordings from the connected device | $43.02 | Monthly |
| 99457 | Monitoring and treatment of the patient for at least 20 minutes throughout the month | $47.87 | Monthly |
| 99458 | Each additional 20 minutes of monitoring | $38.49 | Monthly |
Final Thoughts
CPT Code 99454 is a recurring revenue opportunity that supports better care through remote physiologic monitoring. But to benefit from it, providers must meet strict documentation, device, and usage requirements.
If you’re running or planning an RPM program, now is the time to ensure your billing process is audit-ready and optimized.
CandiHealth helps providers automate 99454 tracking, streamline device management, and improve reimbursement outcomes, without adding operational burden.
Start a free consultation today to see how CandiHealth can simplify your RPM billing.
Related Articles
A Comprehensive Guide to RPM CPT Code 99453
RPM CPT Codes & Reimbursement Rates
Remote Patient Monitoring CPT Codes: Billing & Compliance Guide
Frequently Asked Questions (FAQs)
What is CPT code 99454?
CPT 99454 covers the supply of a medical device and the collection and transmission of physiologic data (e.g., blood pressure, glucose) for at least 16 days in a 30-day period.
How many times can you bill 99454?
You can bill 99454 once every 30 days per patient, as long as 16 days of data are collected and transmitted.
What is the CPT code for CGM monitoring?
The CPT codes for continuous glucose monitoring (CGM) include 95250 for setup and training, and 95251 for data analysis and interpretation.
Can 99457 be billed without 99454?
Yes, but only if RPM data is reviewed for at least 20 minutes and interactive communication with the patient occurs. However, 99454 is typically billed alongside it to reflect device usage.
