The entire healthcare industry has used current Procedural Terminology codes or CPT for a long time. They provide some form of uniformity in the type of service being given by qualified healthcare professionals. Recently, these codes have been updated with regards to remote patient monitoring to make it more robust. Read on to find out just what changes were applied.

Why was the CPT Code Expanded?

The CPT codes are used for billing the Centers for Medicare and Medicaid Services (CMS), thereby creating a revenue model for small and medium medical care providers. The updated CPT codes implemented this year made changes to the Medicare Physician Fee Schedule (PFS). The goal of this change is to make the reporting process for this particular service more streamlined. The change makes it easier to evaluate patient management services and, by extension, increases the value of all of these services.

For remote patient monitoring and other related services, the updated and expanded CPT codes proved to be important. New requirements are now available for remote patient monitoring due to the onset of the COVID-19 outbreak. The CMS made clear what services are billable and what remote monitoring services are allowed. Before the pandemic hit, these devices required at least 16 days’ worth of data within 30 days to qualify for billing. That’s quite a number. However, since the outbreak of COVID-19, CMS has required less than 16 days.

Updated RPM CPT Codes for 2021

There’s a long list of updated codes for RPM because of the recent change. Some of them are:

CPT Code 99453 – This code covers the one-time cost that healthcare providers can charge for enrolling the patient into the new system. If they spent some time setting up the CMS remote patient monitoring systems, whatever the costs incurred are also included here. This makes it easier for healthcare providers to bill for this code once within 30 days.

CPT Code 99454 – This particular code is implemented to allow providers to bill monthly. It’s basically a reimbursement for the cost of leasing the home health care device to the patient, which includes the software used to run this service. The device used should not be previously owned by the patient and should be provided by the healthcare professional. Finally, it should only be used for home care and should be able to automatically upload the data to the provider on a daily basis.

CPT Code 99457 – This code is for the reimbursement for time spent monitoring a patient’s health data. A good example is blood pressure, pulse, and weight data. As such, this can be billed on a monthly basis and requires at least 20 minutes of monitoring for each month.

CPT Code 99458 –  As an add-on to the previous code 99457, this code works to indicate that healthcare providers can be reimbursed for every additional 20 minutes every month. Those 20 minutes are for active monitoring of the patient’s health data only.


Those are just some of the new CPT codes implemented for this year. There are other implementations and changes that healthcare professionals should be aware of. If you want the full list, you can visit the CMS official website

Medistics is at the forefront of medical innovation by giving patients a more accessible level of care. By working with patients and providers through our remote patient monitoring system, we are able to develop person-centered care plans with them. From chronic care management to behavioral health treatment, Medistics Health is here to simplify their experience. Get in touch with us today!

Profit Calculator Assumptions: 40% of total Medicare patients enrolling is based on (i) Medicare Chart Book’s data showing that ~68% of medicare patients qualify for CCM (2 or more chronic conditions), and (ii) that ~40% of eligible patients will enroll.

For typical providers, $46.67 of net profit per patient per month is based on a Medicare reimbursement per patient per month (national average) for various care management CPT codes.

CPT and other codes, descriptions and other data are copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).