CPT Code 99454: Guide to Monthly Device Supply & Data Transmission

CPT code 99454 is one of the core remote patient monitoring (RPM) codes that covers the monthly supply of an FDA-approved device and the transmission of patient-generated health data. Unlike CPT 99453, which is billed once for device setup, 99454 is reimbursed every 30 days as long as the device transmits patient health data for at least 16 days within that period. With remote patient monitoring services under increased scrutiny, including audits by the Office of Inspector General (OIG), accurate RPM billing is more critical than ever.

In this post, we take a deep dive into CPT 99454, covering topics including who can bill the code, requirements to bill 99454, and devices that qualify for the CPT code.

What Is CPT 99454?

99454 is an RPM CPT code that covers the supply and data transmission of an RPM device. Unlike CPT 99453, which is only billed once for device setup and patient education, 99454 can be billed every 30 days as long as the patient meets data transmission requirements.

A unique feature of CPT 99454 is that it is untimed. In other words, it does not require a provider to spend a minimum number of minutes managing the patient for the code to be reportable. Instead, 99454 is based entirely on device-generated data collection for at least 16 days within a 30-day billing period.

Who Can Bill CPT 99454?

CPT 99454 can be billed by:

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

Only one provider can bill for 99454 per patient per 30-day period, even if multiple RPM devices are used by a patient.

Understanding the 99454 RPM Billing Requirements

For providers to receive reimbursement for CPT 99454, these conditions must be met:

• The RPM device must meet the FDA's definition of a medical device.
• Data must be automatically transmitted; manual uploads do not qualify.
• The patient must have 16 or more days of data transmission within a 30-day billing cycle.
• Only one claim per patient per month is allowed, regardless of the number of devices used.

If the patient does not transmit health data for at least 16 days, CPT 99454 cannot be billed.

What Devices Qualify for CPT 99454?

Not all devices meet the criteria for CPT 99454 reimbursement. The device must be FDA-cleared and capable of automatic data transmission to the provider.

Examples of qualifying RPM devices include:

• Blood pressure monitors – used to track hypertension and cardiovascular health
• Weight scales – helps monitor fluid retention in congestive heart failure (CHF) patients
• Pulse oximeters – supports management of respiratory conditions such as COPD
• Blood glucose monitors – essential for diabetes management

The key factor in eligibility is that the device must automatically collect and transmit patient-generated health data to the provider. As noted earlier, manual readings do not qualify. 

CPT 99454 vs. Other RPM Codes

CPT 99454 is part of the larger RPM billing structure. Understanding how 99454 fits within this structure is essential for proper coding, billing, and reimbursement.

CPT 99454 is the only recurring RPM code that is untimed. It is based solely on the transmission of 16-days of health data within a 30-day billing period. Note: For a comprehensive overview of all RPM CPT codes and their specific applications, check out our guide here.

Combining 99454 With Chronic Care Management (CCM)

Many providers pair remote patient monitoring (RPM) with chronic care management (CCM) as part of a larger, more comprehensive care management program to enhance patient care and increase reimbursement. CPT 99454 covers the device supply and 16 days of transmitted health data, while CCM codes like CPT 99490 and CPT 99491 reimburse for time spent reviewing data, adjusting treatment plans, and patient communication. This combination better ensures continuous monitoring with proactive management, leading to improved outcomes and higher revenue.

Here is what the above would look like from a coding and billing perspective:

Best Practices for Billing CPT 99454

To ensure you can bill for CPT 99454 and maximize the code’s value, follow these best practices:

• Verify that a patient’s device transmitted 16-days of health data in a 30-day period
• Monitor device connectivity to prevent transmission failures
• Maintain documentation of data transmission for compliance and audits
• Determine how you can combine 99454 with other care management codes and services for additional reimbursement from interactive monitoring and care management

Avoid These Common Billing Errors

Many providers experience claims denials for CPT 99454 due to simple mistakes. Avoid the following errors:

• Billing for fewer than 16 days of device usage in a 30-day billing period
• Submitting multiple claims for different devices for the same patient; only one CPT 99454 claim is allowed per 30 days
• Using non-FDA-approved devices or billing for manually uploaded device data

CPT Code 99454: Final Thoughts

CPT code 99454 is essential for sustaining a RPM program, providing monthly reimbursement for device supply and data transmission. Unlike other RPM codes, it is not time-based and does not require direct provider interaction. It simply requires patients to record and transmit at least 16 days of physiological data per month.

For providers looking to streamline RPM coding, billing, and compliance, Prevounce offers a comprehensive solution:

• Seamless integration with RPM devices
• Automated billing tracking to prevent missed reimbursements
• Real-time insights on patient eligibility and compliance

Prevounce also offers the Pylo FDA-approved devices that would be eligible for CPT 99454. 

Get More Out of 99454: Speak With Our RPM Experts

Schedule a demo with Prevounce to see how our platform simplifies RPM billing, automates tracking, and helps you achieve improved patient outcomes and financial performance. Book your demo today and take control of your remote patient monitoring 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.