Remote Physiological Monitoring and Cardiovascular Monitoring Service and Billing Information
Table of Contents
- Remote Physiological Monitoring Services
- Remote Cardiovascular Monitoring Services
Remote Physiological Monitoring Services
CPT Codes: 99091, 99453, 99454, 99457, 99458
These codes represent setup, collection and analysis of physiological parameters (e.g., weight, blood pressure, pulse oximetry, blood glucose) over 30-day periods. A minimum of 16 days of data collection is necessary to report these services.
Medical record documentation for these services must include:
- A practitioner order for the approved device (including device name)
- Patient’s condition/diagnosis and the medical necessity of the monitoring of the device
- Patient’s consent to the monitoring
- Date(s) on which the training is provided to the patient
CPT 99453: Billed only once per episode of care, to represent service initiation and patient education, and may represent multiple monitoring devices provided to the beneficiary.
CPT 99454: Billed when the device(s) have recorded and transmitted least 16 days of data (but no more than 30). The billed date of service is the last day that the device recorded the data. The date of service for each instance thereafter would be 30 days from the prior date of billing, when the device recording continued at least 16 days after the prior date of service.
Note: Do not report 99453, 99454 when these services are included in other remote monitoring codes for the same period (e.g., 95250 for continuous glucose monitoring), since this would represent a duplication of services.
Note: Billing time cycles for services listed below with a PC/TC indicator of 2 or 3 do not need to be identical. A TC component of a service may be billed separately from the PC component of the service and billing dates for the two components may be different, depending on when the professional interpretation (PC) of the technical service (TC) is completed.
The chart below provides descriptions for what the codes represent and both billing and frequency details.
Remote Physiological Monitoring
| CPT/HCPCS | Description | PC/TC Indicator | Frequency |
|---|---|---|---|
| 99091 | Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days | 0- This indicator denotes a physician service on which the PC concept does not apply - the service must be billed globally | Once every 30 days-can be billed again on day 31 |
| 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 | 0- This indicator denotes a physician service on which the PC concept does not apply - the service must be billed globally | Can only be billed once per patient at the start of the services. The date of service for CPT 99453 would be the date on which the device records the 16th day of data in a 30-day period following initiation of the service (or the last date of that 30-day period) |
| 99454 | Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days | 0- This indicator denotes a physician service on which the PC concept does not apply - the service must be billed globally | Once during the initial monitoring period, along with 99453,and then once during every subsequent 30-day period. |
| 99457 | Remote physiologic 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 month; first 20 minutes | 0- This indicator denotes a physician service on which the PC concept does not apply - the service must be billed globally | Once per calendar month, billed separately from either 99453 or 99454 |
| 99458 | Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; each additional 20 minutes (List separately in addition to code for primary procedure) | 0- This indicator denotes a physician service on which the PC concept does not apply - the service must be billed globally | Must be billed with primary procedure code 99457 |
Remote Cardiovascular Monitoring Services
CPT Codes: 93295, 93296, 93297, 93298, G2066
Services in this category are designed to remotely monitor functions performed by implantable defibrillators, pacemakers and cardiac rhythm recording devices. As described for the RPM services above, billing time cycles for services listed below with a PC/TC indicator of 2 or 3 do not need to be identical. A TC component of a service may be billed separately from the PC component of the service and billing dates for the two components may be different, depending on when the professional interpretation (PC) of the technical service (TC) is completed.
Remote Cardiovascular Monitoring
| CPT/HCPCS | Description | PC/TC Indicator | Frequency |
|---|---|---|---|
| 93295 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional | 2- This indicator denotes a professional component only of a service - these codes are associated with other codes to represent the TC component of the service | Once every 90 days- can be billed again on day 91 |
| 93296 | Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system, leadless pacemaker system, or implantable defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | 3- This indicator denotes a code representing only the technical component of a service - these codes are associated with other codes representing the professional component of a service | Once every 90 days - can be billed again on day 91 |
| 93297 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, including analysis of 1 or more recorded physiologic cardiovascular data elements from all internal and external sensors, analysis, review(s) and report(s) by a physician or other qualified health care professional | 1- This indicator denotes a professional and technical component of a service. Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense and malpractice expense. The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only. The total RVUs for codes reported without a modifier include values for physician work, practice expense and malpractice expense | Once every 30 days -can be billed again on day 31 |
| 93298 | Interrogation device evaluation(s), (remote) up to 30 days subcutaneous cardiac rhythm monitor system, including analysis of recorded heart rhythm data, analysis, review(s) and report(s) by a physician or other qualified health care professional | 1- This indicator denotes a professional and technical component of a service. Modifiers 26 and TC can be used with these codes. The total RVUs for codes reported with a 26 modifier include values for physician work, practice expense and malpractice expense. The total RVUs for codes reported with a TC modifier include values for practice expense and malpractice expense only. The total RVUs for codes reported without a modifier include values for physician work, practice expense and malpractice expense. | Once every 30 days -can be billed again on day 31 |
| G2066 | Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results | 3- This indicator denotes a code representing only the technical component of a service - these codes are associated with other codes representing the professional component of a service | Once every 30 days -can be billed again on day 31 |
Reviewed 09/17/2024