Our mission is to help you understand how remote care services can be reimbursed and guide you in securing reimbursement for these services.

What is CPT Code 99453?

CPT Code 99453 is a billing code used specifically for Remote Patient Monitoring (RPM) that reimburses healthcare providers for the initial setup and patient education on using remote monitoring devices.

Check this article 6 Essential Steps to Launch a Successful Remote Patient Monitoring based on CPT codes to know easy steps for launching a Remote patients monitoring program. Also you can check The Importance of CPT Codes for RPM to know in detail about the importance of CPT codes for RPM.

CPT Code 99453 addresses the time and effort required to initiate RPM services, including explaining how the technology works, verifying device connectivity, and ensuring the patient understands how to use it to monitor their health data.

Our solution vitalera seamlessly manages CPT Code 99453 by automating device setup documentation and patient education tracking, maximizing compliance and reimbursement for Remote Patient Monitoring programs.

‍

CPT code 99453 is a valuable tool that supports the growth and utilization of remote patient monitoring. It recognizes the importance of the initial setup and education process, ensuring that patients can fully benefit from this innovative approach to healthcare delivery.

Below there are 5 important points to know about  CPT Code 99453:

1) CPT Code 99453 Scope: 

CPT 99453 covers the service of onboarding the patient onto an RPM program. It involves both setting up the remote monitoring device and educating the patient about its use, including how and when to transmit data back to their healthcare provider.

Three key points to remember: 

1. It's a billing code specifically designed for RPM services.
2. It covers the initial setup and patient education phase of RPM.
3. It recognizes the time and effort healthcare providers invest in getting patients started with remote monitoring.

2)Qualifying devices:

CPT Code 99453 is generally used for setting up and educating patients on remote patient monitoring (RPM) devices that collect physiological data. These devices must be FDA-approved or validated to meet the billing requirements for RPM programs. Some commonly used devices include: Blood Pressure Monitors, Glucose Meters, Weight Scales,Pulse Oximeters, Wearable ECG or Heart Rate Monitors and Spirometers.

‍

3) Billing Must-Knows: 

CPT code 99453 can be used once and billed once per patient for data collection for at least 16 days in a 30-day period (episode of care days; not calendar month days).

• Single Use Per Episode: CPT 99453 can only be billed once per episode of care, even if multiple devices are used.
• Non-Face-to-Face Service: No in-person interaction is necessary; it covers services provided remotely.
• No Overlap with Other Services: This code cannot be billed with codes covering face-to-face visits or other types of care management within the same time frame.

4) CPT Code 99453 Reimbursement:

The 2024 average national payment rate for CPT code 99453 is $19.32. This code requires 16 days of patient vital sign data during a 30-day billing period.

‍

CPT Code 99453 supports reimbursement for:

‍

• The initial setup of remote monitoring devices, 
• Patient education, and
• Patient training.

‍

This code specifically covers the onboarding phase, helping providers recover costs associated with device installation and instructional time, essential for effective Remote Patient Monitoring (RPM) programs Remote Patient Monitoring: A Leading Anchor of the 'Hospital-at-Home' Paradigm. 

‍

Medicare and private insurers recognize CPT 99453 as a valuable service, reimbursing healthcare providers for enabling patients with the skills and understanding needed for consistent data sharing, which is essential for quality remote care. Through vitalera, providers can streamline compliance with 99453, ensuring complete and accurate documentation for smoother reimbursements.

Medicare Reimbursement: 

Medicare covers CPT 99453 under the Medicare Physician Fee Schedule (PFS) and requires the service to be provided under the general supervision of a qualified healthcare provider. Providers must meet requirements for accurate documentation of the setup process, including time spent instructing the patient.

Medicaid Reimbursement: 

For Medicaid, CPT Code 99453 also enables reimbursement for the initial setup and training associated with RPM devices. However, Medicaid coverage and reimbursement vary by state, and not all state Medicaid programs have adopted reimbursement for RPM. In states that do cover 99453, Medicaid reimburses healthcare providers for the time and resources needed to onboard patients into RPM, enhancing care for populations with limited access to in-person visits.

5) Limitations and Compliance

• No Device Reimbursement: CPT 99453 does not cover the device itself but only the time and services for setup and patient education.
• Patient Eligibility: Only patients with qualifying chronic conditions or those needing consistent physiological monitoring are eligible.

Using CPT 99453 correctly is essential for compliance and avoiding issues with denied claims. It's a foundational code for initiating RPM programs, ensuring patients can independently monitor their health data accurately, and establishing a strong RPM workflow.

To know thoroughly about CPT codes, you can download our free Guide for CPT Codes for Remote Patient Monitoring.

Contact us.

‍