What Are the Essential RPM CPT Codes? 

At Health Med Affairs, we believe in making healthcare billing easy to understand for providers, clinics, and even patients. 

If you’re offering Remote Patient Monitoring (RPM) services, it’s important to know, “What are the essential RPM CPT codes?” 

Proper insurance billing codes enable you to prioritize patients over claims. 

Below, we’ll explain each RPM CPT code, how to use them, insurance requirements, and how Health Med Affairs supports you every step of the way. 

What Is Remote Patient Monitoring (RPM)? 

Remote Patient Monitoring (RPM) lets caregivers track patients’ health data remotely. Devices like blood pressure cuffs and glucose monitors send data to caregivers, who spot trends and intervene when needed. 

RPM Helps With: 

• Treatment of chronic diseases (e.g., diabetes, COPD, hypertension) 

• Advanced identification of possible complications 

• Reducing hospital readmissions 

• Improving patient outcomes and engagement 

Due to a transition towards value-based care, RPM is not an optional measure anymore; it is a necessity. And the correct coding is making sure that you receive the level of pay that you deserve for doing what you are already doing. 

What Are CPT Codes? 

CPT (Current Procedural Terminology) codes are five-digit medical codes healthcare professionals use to describe services rendered. These codes are required by insurance payers like Medicare, Medicaid, and private insurers to process reimbursement. 

At Health Med Affairs, we specialize in accurate and compliant medical billing and coding, which helps Texas providers avoid claim denials and maximize revenue. 

What Are the Essential RPM CPT Codes? 

Here are the four most important CPT codes for remote patient monitoring services. 

1. 99453 CPT Code 

The CPT code 99453 is used when setting up a patient with an RPM device. 

99453 CPT code description: 

• One-time code per patient 

• Covers device setup and patient education 

• No data needed for billing 

Use this when a new patient starts RPM care. 

2. 99454 CPT Code 

CPT code 99454 is used for the device that collects and shares patient data. 

99454 CPT code description: 

• Billed every 30 days 

• The device must collect data for at least 16 days in that month 

• Data must be automatically sent to the doctor 

This code is only billable if the device sends data at least 16 out of 30 days. 

3. 99457 CPT Code 

CPT code 99457 is used when a doctor or nurse reviews the data and talks to the patient. 

99457 code description: 

• At least 20 minutes of care per month 

• Includes reviewing data and live communication 

• Billed monthly 

This is where real-time patient care is counted. 

4. 99458 CPT Code 

This is an add-on to 99457 when care goes beyond 20 minutes. 

Use when: 

• You spend another 20 minutes with the patient 

• Additional time must be medically necessary 

• Only added after billing 99457 

Remote Therapeutic Monitoring (RTM) Codes 

RTM is similar to RPM, yet it handles non-physiological data. It measures things such as medication adherence, pain levels, and therapy responses. RTM can use self-reported data, unlike RPM. 

Necessary RTM codes include: 

• 98975: Setup and patient education for RTM 

• 98976: RTM for respiratory care (16+ days) 

• 98977: RTM for musculoskeletal care (16+ days) 

• 98980: First 20 minutes of patient-provider communication 

• 98981: Add-on code for extra time 

RTM is typically used by physical therapists, occupational therapists, and non-physician providers. 

Who Can Bill for RPM? 

RPM services can be billed by: 

• Physicians (MD, DO) 

• Nurse practitioners (NPs) 

• Physician assistants (PAs) 

• Clinical staff under direct supervision 

At Health Med Affairs, we help you confirm provider eligibility and ensure correct scope-of-practice alignment when billing for RPM and RTM. 

RPM Billing Codes & Insurance Reimbursement 

At Health Med Affairs, we ensure you use the proper codes with the right payers. Here’s how different insurance programs handle remote patient monitoring CPT. 

Medicare 

Medicare covers both RPM and RTM. But you must meet specific rules. 

Medicare Requirements: 

• Established patient relationship required 

• Must monitor a chronic or acute condition 

• 16-day data needed for 99454 

• One provider per patient per 30 days 

• Must be reasonable and necessary 

• Patient consent is required before the service starts 

• The device must be FDA-approved 

• Data must be electronically collected & uploaded 

Medicare does not allow billing RPM and RTM for the same patient in the same period. 

Medicaid 

Medicaid varies by state. 

In Texas, RPM is reimbursed by select Medicaid Managed Care Organizations (MCOs). Policies differ by region and plan, so verifying each patient’s eligibility is best before billing. 

Our team at Health Med Affairs will: 

• Check state-specific RPM coverage 

• Handle prior authorizations 

• Prevent claim denials for Medicaid billing 

Private Insurance 

Each insurer has its own coverage rules for RPM. 

We help you navigate: 

• Which CPT codes are reimbursable 

• If pre-authorization is required 

• Eligibility criteria for RPM services 

• Documentation needs and audit readiness 

We work with major payers like Blue Cross Blue Shield, Aetna, Cigna, Humana, and more. 

Safety Net Providers (RHCs and FQHCs) 

Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) can bill RPM services separately. 

Requirements include 

• The patient must be established 

• Consent must be documented 

• RPM must be medically necessary 

• Cannot duplicate services already billed 

At Health Med Affairs, we specialize in RPM coding for FQHCs and RHCs across Texas. 

How Often Can These Remote Patient Monitoring CPT Codes Be Used? 

Why Work with Health Med Affairs? 

We’re not just another billing company. At Health Med Affairs, we specialize in medical billing and coding services for providers across Texas, especially those offering RPM and RTM services. 

Our Services Include: 

• Accurate CPT and HCPCS coding 

• Real-time billing and claim submission 

• Reimbursement tracking 

• Denial management 

• Insurance eligibility checks 

• Compliance with CMS guidelines 

We customize our services to fit your workflow. It doesn’t matter if you’re a solo practitioner, part of a multi-specialty group, or an FQHC. Our goal is to help you succeed. 

Conclusion: Understanding the RPM CPT Codes 

So, what are the essential RPM CPT codes? Doctors and clinics need RPM CPT codes to get paid for their work, especially in today’s digital healthcare world. 

To summarize: 

• 99453: Setup and education 

• 99454: Device data collection (16+ days) 

• 99457: 20 minutes of monitoring 

• 99458: Extra time spent with the patient 

Using these RPM billing codes correctly leads to better care, fewer claim rejections, and quicker payments. 

Need Help with RPM Billing? 

Let Health Med Affairs handle your billing, coding, and compliance. We’re your go-to team for RPM CPT codes, RTM billing, and healthcare revenue cycle. Contact us today to simplify your billing process and get paid faster! 

FAQs 

Q: Can a patient enter their data? 

Only for RTM, not RPM. For 99454, the device must automatically upload data. 

Q: Can you bill both RPM and RTM together? 

Medicare prohibits duplicate codes for a single patient in one period. 

Q: What happens if data is not recorded for 16 days? 

Then 99454 cannot be billed. You need 16 full days of data collection in 30 days. 

Q: Can multiple devices be used? 

Yes, however, 99454 is charged once every 30 days for each patient, regardless of the number of devices. 

Q: Is RPM only for chronic conditions? 

No, Medicare allows RPM for both chronic and acute conditions.