CPT Code 99453 – Remote Patient Monitoring Guide

CPT Code 99453 is the billing code for setting up patients with Remote Patient Monitoring devices. It reimburses providers for the time it takes to set-up devices and educate patients on how to use their new at home monitors. This code is different from some of the other CPT codes because it is used only once for every patient rather than a monthly or annual billing code. CPT Code 99543 comes with its own set of rules and qualifications that are mapped out here in this comprehensive guide.

Here is everything you need to know about CPT Code 99453, from billing to payment.

What is CPT Code 99453?

CPT Code 99453 is the billing code for initial patient setup and education into the remote patient monitoring program. It reimburses providers for the time it takes to set-up devices and educate patients on how to use their new at-home monitors. This code is different from some of the other CPT codes because it can only be billed once for every patient rather than recurring.

What services are required for CPT 99453?

The services required for CPT 99453 as specified by Medicare guidelines are: the initial set-up and initial patient education on use of equipment. Medicare additionally requires that a member of the clinical staff or under the supervision of the primary physician spend time helping the patient set up and become comfortable with device use.

When can I bill for CPT Code 99453?

A patient must be monitored for at least 16 days before providers can bill for CPT 99453. The patient must also have completed 16 days of readings within the month to submit the code. These 16 days of readings do not need to be consecutive and do not need to consist of readings from all patient’s devices. For example, a patient could take readings for 8 days with each of their 2 devices to total 16 days of readings.

What devices are used for CPT Code 99453?

The major devices used for code 99453 are:

• Blood Pressure Cuff
• Pulse Oximeter
• Blood Glucose Monitor
• Digital Weight Scale

Can I bill CPT 99453 for set up and education for more than one device for a single patient?

CPT Code 99453 can only be billed one time, which encompasses set up and education for all devices. This code is used to bill for the initial set-up and education of the patient regardless of the number of devices they are using. Other RPM CPT codes can be billed on a recurring basis.

Can a third party deliver CPT 99453 on behalf of the practice?

Yes, a third-party Remote Patient Monitoring partner can deliver CPT 99453 services on behalf of the practice, so long as it is supervised by the primary provider. These third-party partners can educate patients on device set-up and use. Utilizing a third-party partner that specializes in Remote Patient Monitoring, like 100Plus, can alleviate stress from and help physicians and clinicians to run crucial and efficient Remote Patient Monitoring services.

Do RPM devices have to be FDA certified for CPT 99453?

As of 2021, the Physicians Fee Schedule Final Rule has clarified which RPM devices are acceptable medical equipment for Medicare patients. Devices for CPT Code 99453, however, do not need to be specifically FDA-approved. Instead, Medicare specifies that the devices meet the FDA’s definition of a medical device as described in Section 201(h) of the Federal, Food, Drug and Cosmetic Act.

By this standard, the device must:

• Automatically upload patient data to primary physicians and clinicians
• Be relevant to the treatment plan for the patient’s condition
• Collect and transmit data in an accurate and reliable manner