Remote Physiological Monitoring (RPM)

Coding Tip: Remote Physiological Monitoring (RPM)

The Society for Maternal-Fetal Medicine (SMFM) Coding Committee; Trisha Malisch, CCS-P, CPC, COBGC

Introduction

Remote Physiological Monitoring (RPM) continues to expand as an important tool in patient care management, allowing clinicians to monitor patients outside of the traditional clinical setting. Correct coding is essential to ensure compliance and accurate reimbursement. Below is a breakdown of how to report RPM services, along with key documentation and billing rules.

Remote Physiological Monitoring Treatment Management Services (99470, 99457, 99458)

RPM treatment management services involve the clinical staff, physician, or other qualified healthcare professional (QHP) using physiologic data obtained from an FDA‑defined medical device to manage a patient’s treatment plan.

These services require real-time interactive communication with the patient or caregiver during the calendar month.

These codes cannot be billed on a date when an E/M service is reported.

99470 - Remote physiological monitoring treatment management services, clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/caregiver during the calendar month; first 10 minutes

• 99470 became effective 1/1/2026
• Do not report 99470 for services of less than 10 minutes or more than 19 minutes
• Do not report 99470 in conjunction with 99457 or 99458

99457 - first 20 minutes

• This code can be reported once per calendar month, regardless of the number of parameters monitored

• Cannot be reported for services of less than 20 minutes
• Codes 99470 and 99457 cannot be reported in conjunction with codes 93264, 99091
• Cannot be reported in the same calendar month as 99473, 99474

+99458 - each additional 20 minutes (list separately in addition to code for primary procedure)

• Must be reported in conjunction with 99457
• Do not report 99458 for services of less than an additional increment of 20 minutes
• Do not report 99457, 99458 in conjunction with 99470

Supervision & “Incident To” Billing

RPM services reported with 99470, 99457, and 99458 may be billed incident to a physician or QHP under general supervision.

The supervising provider does not need to be the same clinician managing the patient’s broader care; however, only the supervising physician or QHP may bill for the service.

Collection and interpretation of physiologic data (99091)

99091 - Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose) digitally stored and/or transmitted by the patient/caregiver to a physician/QHP; requires ≥30 minutes of physician/QHP time, each 30 days.

• Includes time spent by physician/QHP acquiring, reviewing and interpreting the data (minimum 30 minutes in a 30‑day period)
• Clinical staff time does not count
• Do not report for data transfer/interpretation from clinical lab or hospital computers
• Cannot be billed on a date when an E/M service is reported.
• Does not include interactive communication with the patient/caregiver (for RPM treatment management, see 99470, 99457, 99458)

• Do not report 99091 with 99457, 99458, or 99470, or when a more specific code is available (see 93227, 93272, 95250, etc.)

SMBP Data Review, Averaging & Treatment Planning (99474)

99474 - Self-measured blood pressure using a device validated for clinical accuracy; separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient

Requires analysis of SMBP readings, including calculation of a blood pressure average, and making treatment decisions based on the measurements.

• Report once per calendar month
• Cannot be reported on same date as E/M service
• Do not report in the same calendar month as remote physiologic monitoring, collection and interpretation services (99453, 99445, 99454, 99091, 99470, 99457, 99458)

RPM Setup, Device Supply & Education (99453, 99445, 99454, 99473)

99453 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); initial set-up and patient education on use of equipment

CPT 99453 covers the initial setup and onboarding of an FDA‑defined RPM device. This includes

• Configuring the device
• Activating it for patient use
• Providing education/training to the patient or caregiver on proper operation and data transmission.

99445 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in a 30-day period (Effective 1/1/2026)

99454 - Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 16-30 days in a 30-day period

99445 and 99454 include:

• Monthly device supply and data transmission
• Capture of 2-15 days (99445) or ≥16 days (99454) of readings
• One billing per 30‑day period

Excludes setup (99453) and management time (99457/99458)

99473 – Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration

Covers one-time education, training, and calibration of a self‑measured blood pressure (SMBP) device.

• Billed once per device.
• Not reported if performed as part of an E/M service.

Examples:

1. Patient with type I diabetes has data uploaded for review weekly. During the month of January, 45 cumulative minutes of RPM treatment management was documented, which included insulin adjustments and real-time, interactive communication with the patient.

CPT code 99457 is reported for the first 20 minutes, and CPT code 99458 is reported for the additional 20 minutes. The 5-minute increment cannot be billed.

2. Postpartum patient sends her twice-daily home blood pressure readings from her phone to the MFM office every 7 days. The data is reviewed and interpreted by the nurse practitioner at the MFM practice. For the 30-day monitoring period ending last week, the NP has documented 35 minutes collecting and interpreting the data.

CPT code 99091 is reported for collection and interpretation of physiologic data

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Members should submit any coding questions to the SMFM Coding Committee “Ask a Coding Question” website (https://www.smfm.org/ask-a-coding-or-PM-question). Additional information and resources are also available on our coding website (smfm.org/coding).