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99457 CPT Code: RPM Clinical Staff Time Billing

Last Updated: April 25, 2026

Supplying an RPM device (99454) is only half the battle. The actual clinical management of the patient's data is billed using CPT 99457.

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2026 Medicare National Fee (99457): Non-Facility (Office): $65.26 · Facility (Hospital): $29.47

Time-Based Requirements

99457 ↗ requires exactly 20 minutes of clinical staff/physician time per calendar month spent managing the patient's data.

Crucially, this time MUST include at least one interactive communication with the patient (or caregiver) via phone or video. Simply reviewing the data in the EHR without talking to the patient does not count.

Medical Necessity Documentation

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Your documentation must detail what the data showed, what clinical decisions were made (e.g., adjusting medication), and a summary of the conversation with the patient.

NCCI Edits and Add-ons

If your staff spends 40 minutes, you will bill 99457 for the first 20 minutes, and the add-on code 99458 ↗ for the next 20 minutes. Ensure no overlapping time is billed if the patient is also enrolled in Chronic Care Management (CCM - 99490).

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