July 4, 2020

What is CPT code 99457?

All You Need to Know About Remote Patient Monitoring Code 99457

Although the concept of remote patient monitoring (RPM) is decades old, it was only in 2018 that it gradually gained acceptance and support through the Centers for Medicare & Medicaid Services (CMS).

With the publication of the “Chronic Care Remote Physiologic Monitoring” document, the codes used for incentivizing healthcare providers using RPM technology took effect on January 1, 2019. However, the codes and rules were modified in response to feedback from the medical community and to ensure the best outcomes for patients.

Among these, three remote chronic care management codes were created at the same time by the American Medical Association’s (AMA) CPT Editorial Panel, namely 99453, 99454, and 99457.

In this post, we’ll be focusing on CPT 99457 — what it is all about and how doctors can bill for it.

CPT 99457 explained

The CPT 99457 code refers to RPM treatment management services administered with a minimum of 20 minutes’ duration in one calendar month by a physician, clinical staff, or a qualified healthcare professional.

The inclusion of the term “clinical staff” is probably the primary differentiating factor in CPT 99457 compared to a somewhat similar code like CPT 99091 (which is limited to “physicians and qualified healthcare professionals”).

Here, clinical staff includes but is not limited to registered nurses and medical assistants; that is, subject to the scope of the state law and practice, as well as the supervision requirements embodied in the applicable state law.

Originally, CPT code 99457 could be provided by auxiliary personnel “incident to” the professional services of the billing practitioner. This means that the “incident to” service was administered to a patient with the direct supervision of a physician (as broadly defined by Medicare). It was then billed to Medicare in the name of the physician, subject to specific requirements.

However, beginning January 1, 2020, Medicare modified “direct physician supervision” to “general supervision.” With the latter, the physician and the medical staff or auxiliary personnel are no longer required to be physically present at the same time in the same building.

What is reimbursed?

Under CPT 99457, physicians can bill at least 20 minutes of RPM treatment management services per calendar month and will be reimbursed by CMS on a monthly basis. The reimbursement covers clinical staff time utilized for monitoring and interactive communication with patients, whether by phone, text, or email.

This billing scheme makes it easier to track since billing is based on a calendar month, unlike other codes which are applicable only for 30-day periods. This also makes it easier to keep track of recordkeeping and claims submissions.

Physicians can report 99457 along with chronic care management (CCM) services, transitional care management (TCM) services, principal care management (PCM) services, and behavioral health integration (BHI) services falling within the same service period. However, note that any time spent administering these services must be kept separate, and no reported time can be used to refer to more than one type of service.

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By Darrayl L. Miles

Vice President of Marketing

MedekRPM

www.medekrpm.com