How To Use CPT Code 99454

CPT 99454 is a code used for remote monitoring of physiologic parameters, with device supply and daily recordings or programmed alerts transmission for each 30 days. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 99454.

1. What is CPT 99454?

CPT 99454 is a medical billing code used for remote monitoring of physiologic parameters, such as weight, blood pressure, pulse oximetry, and respiratory flow rate. This code is used when a healthcare provider supplies the patient with remote monitoring equipment and receives daily recordings and/or programmed alerts for each 30 days of equipment supply and monitoring.

2. 99454 CPT code description

The official description of CPT code 99454 is: “Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.”

3. Procedure

The 99454 procedure involves the following steps:

  1. Healthcare provider assesses the patient’s need for remote physiologic monitoring.
  2. Provider supplies the patient with appropriate remote monitoring equipment.
  3. Patient uses the equipment to record and transmit physiologic data daily or as programmed alerts.
  4. Provider reviews the recorded data and alerts, and takes necessary actions based on the information received.
  5. Provider bills CPT 99454 for each 30 days of equipment supply and monitoring.

4. Qualifying circumstances

Patients eligible to receive CPT code 99454 services are those who require remote monitoring of physiologic parameters due to chronic or acute medical conditions, such as hypertension, heart failure, diabetes, or chronic obstructive pulmonary disease (COPD). The healthcare provider must determine that remote monitoring is medically necessary and beneficial for the patient’s health management.

5. When to use CPT code 99454

It is appropriate to bill the 99454 CPT code when the following conditions are met:

  • The patient has a medical condition that requires remote monitoring of physiologic parameters.
  • The healthcare provider has determined that remote monitoring is medically necessary and beneficial for the patient’s health management.
  • The provider supplies the patient with remote monitoring equipment and receives daily recordings and/or programmed alerts for each 30 days of equipment supply and monitoring.

6. Documentation requirements

To support a claim for CPT 99454, the following information needs to be documented:

  • Medical necessity for remote monitoring of physiologic parameters.
  • Specific physiologic parameters being monitored.
  • Type of remote monitoring equipment provided to the patient.
  • Frequency of daily recordings or programmed alerts transmission.
  • Provider’s review and interpretation of the recorded data and alerts.
  • Actions taken by the provider based on the received information.

7. Billing guidelines

When billing for CPT code 99454, keep in mind the following guidelines and rules:

  • Bill CPT 99454 for each 30 days of equipment supply and monitoring.
  • Do not report CPT 99454 for monitoring of less than 16 days.
  • Do not report CPT 99453, 99454 in conjunction with codes for more specific physiologic parameters (eg, 93296, 94760).
  • For initial setup and training on remote monitoring equipment, see CPT 99453.
  • For physiologic monitoring treatment management services, use CPT 99457.

8. Historical information

CPT 99454 was added to the Current Procedural Terminology system on January 1, 2019. There have been no updates to the code since its addition.

9. Similar codes to CPT 99454

Five similar codes to CPT 99454 and how they differentiate are:

  1. CPT 99453: This code is used for the initial setup and patient education on the use of remote monitoring equipment, rather than the ongoing monitoring and equipment supply.
  2. CPT 99457: This code is used for remote physiologic monitoring treatment management services, which involve the provider’s active management of the patient’s condition based on the received data.
  3. CPT 93296: This code is specific to remote monitoring of implantable cardiovascular devices, such as pacemakers and defibrillators, and not general physiologic parameters.
  4. CPT 94760: This code is used for noninvasive ear or pulse oximetry for oxygen saturation, which is a single measurement and not ongoing remote monitoring.
  5. CPT 98975: This code is used for remote therapeutic monitoring, which involves the monitoring of patient compliance with a prescribed treatment plan, rather than physiologic parameters.

10. Examples

Here are 10 detailed examples of CPT code 99454 procedures:

  1. A patient with hypertension is provided with a blood pressure monitor and instructed to transmit daily readings to their healthcare provider for a 30-day period.
  2. A patient with heart failure is given a weight scale and pulse oximeter to monitor daily weight and oxygen saturation levels, with data transmitted to their healthcare provider for 30 days.
  3. A patient with diabetes is supplied with a continuous glucose monitor that transmits daily glucose readings to their healthcare provider for a 30-day period.
  4. A patient with COPD is provided with a respiratory flow rate monitor to record daily expiratory flow rates and transmit the data to their healthcare provider for 30 days.
  5. A patient with a history of arrhythmias is given a wearable heart rate monitor that transmits daily heart rate data and programmed alerts to their healthcare provider for a 30-day period.
  6. A patient with chronic kidney disease is provided with a weight scale and blood pressure monitor to track daily weight and blood pressure readings, with data transmitted to their healthcare provider for 30 days.
  7. A patient with a recent stroke is given a blood pressure monitor and pulse oximeter to monitor daily blood pressure and oxygen saturation levels, with data transmitted to their healthcare provider for a 30-day period.
  8. A patient with congestive heart failure is supplied with a weight scale, blood pressure monitor, and pulse oximeter to track daily weight, blood pressure, and oxygen saturation levels, with data transmitted to their healthcare provider for 30 days.
  9. A patient with asthma is provided with a peak flow meter to record daily peak expiratory flow rates and transmit the data to their healthcare provider for a 30-day period.
  10. A patient with a history of syncope is given a wearable heart rate monitor that transmits daily heart rate data and programmed alerts to their healthcare provider for a 30-day period.

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