CPT code 99454 is a billing code for providing and monitoring remote patient monitoring equipment for patients, which reimburses the supplier for the continuous supply of equipment and remote patient monitoring. This code can be billed monthly, but no matter how many devices the patient has, each patient can only be billed once a month. CPT code 99454 comes with a unique set of rules and qualifications.
1) What services does CPT code 99454 need?
CPT code 99454 service covers continuous equipment supply and patient monitoring. It also covers the costs associated with renting remote patient monitoring medical devices.
2) Who is eligible for CPT code 99454?
All patients in remote areas covered by Medicare are eligible for CPT code 99454. With the expansion of the number of remote patients brought by COVID-19 pandemic, more Medicare patients are eligible for these CPT codes.
3) What equipment does CPT code 99454 use?
The main devices used for code 99454 are: blood pressure monitor, pulse oximeter, blood glucose monitor and digital scale.
4) Does CPT code 99454 cover device cost?
For billing, CPT code 99454 covers the monthly service cost of device and treatment services.
5) How to use CPT code 99454 to get reimbursement for remote patient monitoring?
Providers can be remunerated for their remote patient monitoring work by using the correct CPT code. For CPT code 99454, to provide device and monitor the monthly bill of the patient, the patient’s attending physician or clinician must order the device. Primary physicians or clinicians are also required to provide invoices for device costs and device related services. CPT code 99454 requires 16 days of patient data readings within a 30 day billing period.
6) Can a patient have multiple RPM devices under CPT 99454? According to CPT code 99454, a single patient can have multiple remote patient monitoring devices, but the supplier can only charge each patient once every 30 days, and only when patient data is recorded for at least 16 days, even if multiple devices are provided.
7) Does RPM device have to pass FDA certification with CPT code 99454? In the latest CMS-1693-F final rules, Centers for Medicare and Medicaid Services didn’t clarify the specific technology or device type applicable to CPT code 99454. CMS has declared that the device must be “FDA defined medical device”. Medicare does not require the device to obtain FDA “approval”, but certain suppliers may require FDA approval of RPM devices.
8) Who must work for each remote patient monitoring service?
The work of each remote patient monitoring service must be ordered by the patient’s doctor or clinician and must be monitored for at least 16 days before the provider can bill for CPT code 99454.