The Key Points to Keep in Mind When Billing CPT® Code 99458 for Remote Patient Monitoring

CPT® code 99458 covers the additional time your clinical team (or outsourced team) invests in monitoring patients after the 99457 time requirements have been met.

Here are the most important things you need to know to bill CPT® Code 99458 correctly using Vianova’s RPM platform.

Who Can Order 99458 and Provide Clinical Monitoring Services?

Like all Remote Physiologic Monitoring (RPM), a physician or other qualified healthcare provider (QHCP) can order RPM for the patient when they believe the prescription is medically necessary. Like 99457, the monitoring can be conducted by clinical staff under general supervision of the physician or QHCP. This means clinical staff, including nurses, can be remote or outsourced. Medical assistants (MAs) may qualify as clinical staff, but this can vary based on state law.

If a physician or QHCP conducts the monitoring, they may be eligible to bill at a higher reimbursement rate using CPT® code 99091.

What Activities Contribute to Clinical Monitoring?

The same activities that contribute to clinical monitoring for 99457 also count for 99458 monitoring time, including monitoring and analyzing patient data, patient communication, patient education, coordination with other care team members, and updating a patient’s care plan.

Time Requirements

99458 can be billed once you have met the requirements (20 minutes of engagement and one live synchronous call) for 99457. In other words, you can bill 99458 for minutes 21-40 of medically necessary patient engagement. You can also bill 99458 twice if you meet the 20 minute requirement, or for minutes 21-40. Note: you must have a second live or synchronous call to bill 99458.

99458 Code Dependencies and Billing Frequency

99458 can only be billed in conjunction with 99457. Both 99457 and 99458 can be billed even if the requirements for 99454 are not met. CMS has not placed a limit on the number of times 99458 can be billed in a calendar month, but any time spent engaging with the patient should be medically necessary.

Reimbursement Rates

According to the CMS CPT© Guidebook, Professional Edition 2023, the national average reimbursement rate for 99458 is $38.68, but rates will vary by geography and location. Vianova’s RPM platform makes it easy to track and bill for these services, ensuring that you receive the maximum reimbursement for your efforts.

Why Choose Vianova’s RPM Platform?

Vianova’s RPM platform is designed to help healthcare providers improve patient outcomes and streamline billing processes. With Vianova, you can easily track patient data, engage with patients in real-time, and bill for remote care services, including CPT® code 99458.

Here are some of the benefits of using Vianova’s RPM platform:

• Easy Patient Enrollment: Vianova makes it simple to enroll patients in your RPM program and track their progress over time.
• Real-Time Patient Monitoring: With Vianova, you can monitor patient data in real-time, allowing you to detect potential health issues before they become serious problems.
• Seamless Billing Integration: Vianova’s RPM platform integrates seamlessly with your billing system, making it easy to track and bill for remote care services, including CPT® code 99458.
• HIPAA-Compliant Data Security: Vianova is fully HIPAA-compliant, ensuring that your patient data is always safe and secure.

In conclusion, if you’re looking to improve patient outcomes, streamline your billing processes, and earn additional revenue for your practice, Vianova’s RPM platform is the most suitable solution for you.