May 20, 2020

CPT codes for remote patient monitoring

Recent Changes in CPT Coding For Remote Patient Monitoring

For over five decades, the American Medical Association has produced a series of codes designed to create uniform reporting materials. Below are special CPT codes for remote patient monitoring.

Current Procedural Terminology codes serve as a vital means to help medical professionals communicate effectively. Providing codes for medical services and procedures helps to make reporting more efficient and more accurate.

CPT codes are also used for insurance claim processing and other paperwork. The AMA regularly reviews the list of CPT codes to maintain and update available information.

Three Categories of CPT Codes

CPT codes come in three separate categories. Each category has its own purpose and grouping of procedures, services or other elements of care.

Category I

Category I codes all correspond to a currently available procedure or service, especially those widely and regularly performed. These codes indicate that the procedure or service has passed federal Food and Drug Administration standards.

Many category I codes also fall under subcategories for more precise usage.

Category I code usage is almost always mandatory.

Category II

Category II codes, conversely, are always optional. These alphanumeric codes are supplemental. Often, professionals use them for performance measurement. Specifically, they relate to the quality of care provided. Medical professionals should never substitute these for category I codes.

Category III

The medical community uses category III codes for emerging technology, new procedures and services, as well as other advancements. Many of these may not have yet passed FDA approval. Others are still in the research and study stage. These receive temporary codes.

Special CPT Codes for Remote Patient Services and Billing

Telemedicine, especially in this recent outbreak of coronavirus, has emerged as a powerful instrument in the treatment toolkit. Last fall,two new codes were created to clarify remote patient monitoring services for purposes of billing. They are:

  • 99457: refers to remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes
  • 99458: refers to remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure)

These codes establish the primary services provided, along with extra treatment time when needed.

With the medical situation still fluid nationally, keep checking for new developments in medical coding related to local, state and national restrictions on movement.