Guide to CPT 99457: Understanding the Code for Initial 20 Minutes of RPM

Proper coding and billing are essential for sustaining a successful remote patient monitoring (RPM) program while ensuring providers receive full reimbursement for their services. Accurate use of RPM CPT codes like 99457 helps prevent claim denials, reduces the risk of audits, and keeps revenue streams stable. Clear documentation of patient interactions and care management time supports compliance, especially important given the increased attention to RPM compliance by the Office of Inspector General (OIG). 

By following the rules and best practices for RPM coding and billing, healthcare providers can spend less time working to get paid and more time delivering high-quality patient care. Read on to learn more about CPT 99457.

What Is CPT Code 99457?

CPT code 99457 applies to RPM treatment management services. It covers at least 20 minutes of clinical staff, physician, or other qualified healthcare professional time in a calendar month, including interactive communication with the patient or caregiver. This code reimburses providers for monitoring patient data, making treatment adjustments, and engaging with patients in an effort to improve their health outcomes.

Key Aspects of CPT Code 99457

Here a few of the key aspects you know about RPM CPT code 99457:

• Purpose: Covers more than 20 minutes and less than 40 minutes per month spent on RPM and interactive communication with the patient or caregiver.
• Reimbursement (2025): The national average reimbursement rate is approximately $48.14, though this figure may vary depending on geographic location and specific payer contracts.
• Billing frequency: This code can be billed once per calendar month for each patient receiving remote patient monitoring services.

Who Can Bill for CPT 99457?

Healthcare professionals eligible to bill for CPT 99457 include:

• Physicians
• Advanced practice registered nurses (APRNs)
• Clinical staff working under the general supervision of a qualified healthcare professional

The supervision requirement varies by state and payer, so it’s important to review specific guidelines before billing.

CPT 99457 Eligibility and Billing Requirements

To bill for CPT 99457, providers must meet specific requirements:

• Interactive communication: At least one real-time, synchronous interaction with the patient or caregiver must occur each month. Phone or video calls qualify, but text messages and voicemails do not.
• Time documentation: Providers must track a minimum of 20 minutes spent on activities such as patient health data review, patient communication, care coordination, and treatment plan modifications. Keeping detailed records is essential for compliance and reimbursement.
• Qualified providers: Services must be provided by a physician, other qualified healthcare professional, or clinical staff operating under the general supervision of the billing provider.

Other RPM Codes and Their Uses

CPT 99457 is just one part of RPM billing and coding. Here’s how it compares to other RPM codes:

These codes work together to ensure that providers are properly compensated for both the setup and ongoing management of RPM programs.

Choosing Between RPM 99457 or Chronic Care Management Codes?

Many practices choose to combine RPM with chronic care management (CCM) rather than relying solely on CPT 99457 for billing time spent on care management. Instead of using CPT 99457 for care management, they bill CPT 99454 for the device supply and 16 days of transmitted data, while leveraging CCM codes like 99490 and 99491 to cover time spent reviewing patient data, adjusting treatment plans, and engaging in patient communication. This approach allows providers to ensure continuous monitoring and proactive intervention while increasing their reimbursement potential. 

By integrating RPM with CCM, practices can deliver more comprehensive care, improve patient outcomes, and generate higher revenue through streamlined, well-documented billing strategies. Here’s what that looks like in 2025:

Best Practices for RPM and CPT 99457

Some best practices to ensure ongoing RPM compliance and reimbursement include:

• Set clear patient expectations: During onboarding, inform patients about the necessity of regular communication and data transmission. Ensure they understand that a live interaction (as defined by CPT 99457) is required each month.
• Utilize efficient time-tracking tools: RPM platforms with automated time tracking help providers log their time spent on remote patient monitoring, making accurate, compliant documentation easier.
• Optimize staffing models: Depending on patient volume, assigning dedicated staff to RPM services or working with third-party monitoring companies can help ensure efficient program management and make it easier to grow a remote patient monitoring program.
• Engage patients meaningfully: Building strong patient-provider relationships can increase engagement and compliance. Personalized outreach and education improve participation in RPM programs.

Get Started With RPM Today!

CPT code 99457 is one of the key components of remote patient monitoring, helping ensure providers receive proper reimbursement for valuable patient management activities. By pairing an understanding of coding and billing requirements, reliable technology, effective patient engagement, seamless integration with healthcare workflows, and other best practices, healthcare organizations can launch and grow RPM programs that improve patient outcomes, maintain compliance, and help provide greater financial stability.

Prevounce is the partner of choice for providers nationwide looking to launch or grow their remote patient monitoring programs. Schedule a demo with our care management experts to see how our platform simplifies RPM and will help you achieve a successful, scalable program.

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Disclaimer

Health economic and reimbursement information provided by Prevounce is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules, and policies. This information is presented for illustrative purposes only and does not constitute reimbursement or legal advice.

Prevounce encourages providers to submit accurate and appropriate claims for services. It is always the provider’s responsibility to determine medical necessity, the proper site for delivery of any services, and to submit appropriate codes, charges, and modifiers for services rendered. It is also always the provider’s responsibility to understand and comply with Medicare national coverage determinations (NCD), Medicare local coverage determinations (LCD), and any other coverage requirements established by relevant payers which can be updated frequently.

Prevounce recommends that you consult with your payers, reimbursement specialists, and/or legal counsel regarding coding, coverage, and reimbursement matters.

Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding, or site of service requirements.