Quick Guide to CPT Code 99458 | Prevounce

Remote patient monitoring (RPM) continues to evolve and cement its position as a key component of modern healthcare, improving patient outcomes while offering providers a reliable revenue stream. Proper understanding and use of RPM codes, including CPT 99458, ensures practices receive appropriate reimbursement while maintaining compliance with Medicare guidelines. Accurate RPM coding is increasingly important given the increased attention to RPM compliance from regulatory agencies.

This post, part of a series of posts discussing the primary RPM CPT codes, focuses on CPT 99458 — its definition, rules, who can bill the code, and more.

CPT code 99458 is an add-on code used in RPM billing. It allows providers to be reimbursed for each additional 20-minute increment spent on remote patient monitoring beyond the first 20 minutes covered under CPT 99457. The 99458 code ensures that healthcare professionals are compensated for the extra time spent managing patient data, making clinical decisions, and engaging in interactive communication with patients.

Key Details of CPT Code 99458

Here a few of the key aspects to know about RPM CPT code 99458:

• Purpose: 99458 covers each additional 20 minutes of time spent on RPM care management and interactive communication with the patient or caregiver beyond the initial 20 minutes billed under CPT 99457.
• Reimbursement (2025): Approximately $38.49 (Medicare non-facility rate).
• Billing frequency: up to two times per month.

Who Can Bill for CPT 99458?

The following healthcare professionals are eligible to bill for CPT 99458:

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

Billing Requirements for CPT 99458

To ensure proper reimbursement for 99458, the following criteria must be met:

• The patient must be enrolled in an RPM program.
• Only one provider may bill for RPM services per patient per month.
• The provider or clinical staff must spend at least 21 minutes per month managing patient data and engaging in interactive communication.
• CPT 99458 can only be billed after CPT 99457 has been billed for the first 20 minutes of RPM management.

How Many Times Can 99458 Be Billed per Patient in a Calendar Month?

Practices can generally bill 99458 twice per month along with one unit of 99457. This means that if a practice records between 40 and 60 minutes of patient time within a calendar month, it should submit a claim for 99457 along with two units of 99458 (one for between 20 and 40 minutes, and another for between 40 and 60 minutes). For 60 or more minutes, there is generally no additional use of 99458 permitted. The claim should include 99457 and two units of 99458.

How CPT 99458 Fits Into RPM Billing

RPM billing follows a structured model based on time spent managing a patient’s care. Below is a breakdown of RPM codes:

A typical RPM billing structure begins with 99457 for the first 20 minutes of interactive communication and monitoring. If additional time is required, providers can bill 99458 once (for a total of up to 40 minutes) or twice (for a total of up to 60 minutes).

Choosing Between 99458 or Other Care Management Codes

If your practice is consistently reaching 20 or more minutes of care management time and meeting the requirements for RPM CPT codes 99457 and 99458, it may be beneficial to integrate RPM with chronic care management (CCM). By leveraging CCM codes such as CPT 99490 and CPT 99491 instead of relying solely on CPT 99457 and CPT 99458 for care management, practices can enhance both patient care and revenue potential. 

Under this approach, RPM CPT code 99454 is billed for device supply and 16 days of transmitted data, while CCM codes account for time spent reviewing patient data, adjusting treatment plans, and engaging in patient communication. This combination allows providers to increase reimbursement while ensuring continuous patient monitoring and proactive intervention. Integrating RPM with CCM supports a more comprehensive care model, improving patient outcomes and creating a more efficient, well-documented billing strategy.

Here’s what this looks like in 2025:

Best Practices for Billing CPT 99458

To better ensure proper reimbursement and maintain compliance, follow these best practices:

• Accurately track RPM time: Maintain detailed records of time spent on patient data analysis and communication.
• Bill only after 99457: Do not bill 99458 unless at least 20 minutes have already been accounted for under 99457.
• Set clear patient expectations: Inform patients about the necessity of regular communication and data transmission. Ensure they understand that a live interaction (as defined by CPT 99457 and 99458) is required each month

Get Started With Compliant RPM Billing Today!

By utilizing CPT 99458 effectively, healthcare providers can offer more comprehensive remote patient monitoring while securing fair compensation for their efforts. This code supports increased patient engagement, enhances chronic disease management, and allows providers to deliver high-quality care without financial limitations.

To best ensure your RPM program is optimized for compliance and reimbursement, schedule a demo with Prevounce. We’ll show you how our platform is simplifying RPM billing, tracking time effectively, and improving patient outcomes for providers nationwide.

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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.