It all begins with a simple coding error, and your hard work becomes meaningless. While Remote Patient Monitoring (RPM) does not have a large code set like others, some of its codes are add-ons. You know what that means? They cannot be billed separately!
Don’t know how to bill add-on codes correctly? Let us help you explore one such timed Current Procedural Terminology (CPT) code for physiologic remote monitoring. Read our step-by-step guide to learn everything you need to know about CPT code 99458, from a detailed description to different scenarios explaining its proper usage.
Before that let’s first understand what RPM is!
Remote Patient Monitoring (RPM)
Unnecessary hospital visits are both time- and resource-consuming. Remote Patient Monitoring (RPM) is the perfect solution for reducing healthcare costs. RPM is simply the use of digital devices by healthcare providers to monitor patients outside of a traditional hospital setting.
This medical practice improves patient-provider communication and allows healthcare providers to detect and manage a wide variety of conditions. Introduced in 2019 by the Centers for Medicaid and Medicare Services (CMS), RPM codes cover several aspects, including:
- Device setup
- Patient education on device usage
- Device supply
- Management of patient treatment
Today, these codes are primarily used for observing a patient’s physiologic parameters, such as blood pressure, weight, pulse oximetry, or respiratory flow rate. Medicare covers RPM under part B of its program, paying 80% of the approved cost. The rest 20%? It is usually a patient’s responsibility unless covered by Medigap policy.
Remember that only one healthcare provider can bill for RPM per patient in a month. In other words, this service is billed only once in a 30-day period.
99458 CPT Code – Description
Some patients require extra care. Therefore, healthcare providers often spend additional time monitoring them. But how do you bill for that extra time? With CPT code 99458, of course!
This RPM code is different from others. It is an add-on code to CPT code 99457, which covers the first 20 minutes a healthcare provider spends on remote observation and management of a patient’s physiologic data, such as blood pressure, glucose levels, and weight.
If a patient requires more time than the defined initial limit, use CPT 99458 to bill for each extra 20 minutes of clinical staff time and interactive communication spent on physiologic monitoring within a calendar month.
It is important to note that CPT code 99458 is not standalone. You must always report it alongside CPT code 99457. Also, remember that while there is no limit on how many units of 99458 you can bill, it is legally advised to limit billing to 2 units.
In other words, you can claim reimbursement for up to 40 minutes of additional patient monitoring after the first 20 minutes covered by 99457 in a calendar month, resulting in 60 billable minutes.
Scenarios Where CPT Code 99458 is Applicable
By now, it must be clear that patients who qualify for RPM use medical devices to measure and transmit their physiologic data to healthcare providers.
After analyzing the provided information, healthcare providers communicate with patients in real time to offer guidance, including adjusting treatment plans, recommending lifestyle changes, or prescribing medications. Each virtual encounter lasts 20 minutes per patient within a calendar month. Anything beyond that requires CPT code 99458.
This code is very straightforward. But if you are still confused, here are a few scenarios in which CPT 99458 is applicable.
Hypertension Management
A hypertension patient at risk of heart disease and stroke is enrolled in an RPM program. The patient uses a remote blood pressure monitoring device to record his BP multiple times a week and sends the data to the healthcare provider. The provider reviews these readings, and during their monthly virtual meeting, the provider spends the initial 20 minutes offering real-time consultation.
He then extends the time to adjust medications and provides educational counseling. Since the provider spent an additional 20 minutes after the first 20 minutes, he uses CPT code 99458 (one unit) alongside CPT code 99457.
Chronic Disease (Diabetes) Monitoring & Management
A patient with type 2 diabetes enrolls in an RPM program to reduce hospital visits. The healthcare provider uses a continuous glucose monitor (CGM) (a wearable device) paired with an app to observe the patient and detect abnormalities, such as blood sugar spikes or lows.
During the monthly virtual encounter, the provider reviews the data for the first 20 minutes and spends an additional 40 minutes due to multiple abnormalities. He uses that time to adjust the insulin dosage and recommends lifestyle changes, including diet and exercise. Since the provider spent 60 minutes in total, he reports CPT code 99457 with two units of CPT code 99458.
Asthma Management
Did you know that nearly 28 million people in the U.S. have asthma? While it is not curable, it is manageable. RPM has proven to be an effective management solution. For example, a healthcare provider may use a spirometer—a device for measuring the amount of air a person can inhale or exhale—to support and manage an asthma patient.
After utilizing the time covered by CPT code 99457, the provider spends an additional 20 minutes making appropriate adjustments, including prescribing medications after observing the patient’s condition. The provider then uses the add-on CPT code 99458 to bill for the extra time.
Billing & Coding Guidelines for CPT Code 99458
Simply follow these guidelines to avoid basic mistakes:
Verify RPM Eligibility
Always verify whether a patient is eligible for RPM services to avoid surprises. Additionally, review their insurance plan to confirm that your services are covered before spending time with the patient or filing any claims.
Meet & Exceed the Set Time Limit of CPT Code 99457
You can only apply CPT code 99458 if you meet and exceed the 20-minute requirement of CPT code 99457, which involves real-time communication with the patient. This add-on code allows you to bill for each additional 20 minutes of engagement.
However, limit the use of this code to two units. Keep in mind that the extra time should be medically necessary. Otherwise, insurers may reject your request for compensation.
Track the Time Spent with Documentation
With numerous patients requiring your attention, how do you remember how much time you spent with each patient or their caregivers to report it correctly? The answer is proper documentation! Record each virtual encounter to track the time you spent communicating with each patient, reviewing their data, and adjusting the care plan.
Documentation also helps justify the medical necessity. Therefore, you should document why the extra time was needed and record all physiological data accurately, including glucose levels, blood pressure, and weight.
Improve Compliance
The most important thing is to remain compliant with state regulations, such as HIPAA and Medicare guidelines. Protect sensitive information and adhere to the payer-specific guidelines for CPT code 99458. Keep in mind that reimbursement rates for this code may vary depending on the insurance company and region.
Summary
To summarize, RPM is a monthly billable program, and CPT code 99458 is an important add-on code for reporting extra time. This means it is always reported together with CPT code 99457. Billing each additional 20 minutes, CPT code 99458 allows healthcare providers to receive payments for their extra efforts.
RPM is a cost-effective, modern medical practice with a small coding set. However, you can only maximize the benefits of your Remote Patient Monitoring services through a complete knowledge of associated codes, including their limitations, correct usage, and documentation requirements. We have provided all the details about this add-on code to help you avoid unexpected claim rejections.
Frequently Asked Questions
