How To Use CPT Code 99457

CPT 99457 refers to remote physiologic monitoring treatment management services provided by clinical staff, physicians, or other qualified healthcare professionals. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99457.

1. What is CPT 99457?

CPT 99457 is a medical billing code used to represent remote physiologic monitoring treatment management services provided by clinical staff, physicians, or other qualified healthcare professionals. These services involve monitoring a patient’s remote physiologic recordings and/or programmed alerts, and interacting with the patient or caregiver to adjust treatment based on the recordings. This code is used for the first 20 minutes of the provider’s time spent providing this service.

2. 99457 CPT code description

The official description of CPT code 99457 is: “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.”

3. Procedure

The 99457 procedure involves the following steps:

1. Provider receives remote physiologic recordings and/or programmed alerts from the patient’s monitoring equipment.
2. Provider evaluates the recordings to track and report physiologic parameters such as weight, blood pressure, blood oxygen levels, and expiratory flow rate.
3. Provider communicates with the patient or caregiver to adjust the patient’s management based on the patient’s reports.
4. Provider documents the time spent providing this service, which should be at least 20 minutes for CPT 99457 to be billed.

4. Qualifying circumstances

Eligible recipients of CPT code 99457 services include patients who require remote physiologic monitoring due to chronic conditions, post-surgical care, or other medical needs. The provider must be a clinical staff member, physician, or other qualified healthcare professional. Additionally, the service must involve interactive communication with the patient or caregiver during the month and require at least 20 minutes of the provider’s time.

5. When to use CPT code 99457

It is appropriate to bill the 99457 CPT code when the following conditions are met:

• The patient requires remote physiologic monitoring due to a medical need.
• The provider is a clinical staff member, physician, or other qualified healthcare professional.
• Interactive communication with the patient or caregiver occurs during the month.
• The provider spends at least 20 minutes providing this service.

6. Documentation requirements

To support a claim for CPT 99457, the following information must be documented:

• Patient’s medical need for remote physiologic monitoring.
• Provider’s qualifications as a clinical staff member, physician, or other qualified healthcare professional.
• Details of the interactive communication with the patient or caregiver, including date and time.
• Duration of the provider’s time spent providing this service, which must be at least 20 minutes.

7. Billing guidelines

When billing for CPT code 99457, keep in mind the following guidelines and rules:

• Report 99457 once each 30 days, regardless of the number of parameters monitored.
• Do not report 99457 for services of less than 20 minutes.
• Do not report 99457 in conjunction with 93264, 99091.
• Do not report 99457 in the same month as 99473, 99474.
• For each additional 20 minutes, report 99458 in addition to 99457.

8. Historical information

CPT 99457 was added to the Current Procedural Terminology system on January 1, 2019. The code was changed on January 1, 2020, with the previous descriptor being “Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month.”

9. Similar codes to CPT 99457

Five similar codes to CPT 99457 and how they differentiate are:

• CPT 99458: Represents additional 20-minute increments of remote physiologic monitoring treatment management services beyond the initial 20 minutes covered by CPT 99457.
• CPT 99473: Involves self-measured blood pressure monitoring, including patient education and device calibration.
• CPT 99474: Covers self-measured blood pressure monitoring with separate review and interpretation of each reading by a qualified healthcare professional.
• CPT 93264: Refers to remote monitoring of a patient’s implanted cardiac device(s) without interactive communication.
• CPT 99091: Represents the collection and interpretation of physiologic data without the interactive communication component.

10. Examples

Here are 10 detailed examples of CPT code 99457 procedures:

1. A patient with congestive heart failure requires remote monitoring of weight and blood pressure to manage their condition. The provider spends 25 minutes reviewing the data and communicating with the patient to adjust their treatment plan.
2. A post-surgical patient requires remote monitoring of their blood oxygen levels and expiratory flow rate. The provider spends 20 minutes evaluating the data and discussing adjustments to the patient’s care with their caregiver.
3. A patient with diabetes requires remote monitoring of their blood glucose levels. The provider spends 30 minutes reviewing the data and communicating with the patient to adjust their insulin dosage and diet plan.
4. A patient with hypertension requires remote monitoring of their blood pressure. The provider spends 22 minutes evaluating the data and discussing medication adjustments with the patient.
5. A patient with chronic obstructive pulmonary disease (COPD) requires remote monitoring of their blood oxygen levels and expiratory flow rate. The provider spends 20 minutes reviewing the data and communicating with the patient to adjust their treatment plan.
6. A patient with a history of arrhythmias requires remote monitoring of their heart rate and rhythm. The provider spends 25 minutes evaluating the data and discussing any necessary adjustments to the patient’s care with their caregiver.
7. A patient with chronic kidney disease requires remote monitoring of their weight and blood pressure. The provider spends 20 minutes reviewing the data and communicating with the patient to adjust their treatment plan.
8. A patient with a history of deep vein thrombosis requires remote monitoring of their blood clotting parameters. The provider spends 23 minutes evaluating the data and discussing any necessary adjustments to the patient’s care with their caregiver.
9. A patient with a history of seizures requires remote monitoring of their electroencephalogram (EEG) data. The provider spends 20 minutes reviewing the data and communicating with the patient to adjust their treatment plan.
10. A patient with a history of sleep apnea requires remote monitoring of their sleep patterns and oxygen levels. The provider spends 21 minutes evaluating the data and discussing any necessary adjustments to the patient’s care with their caregiver.