In modern healthcare delivery, telemedicine and RPM services have emerged as fundamental and indispensable elements of patient care and management. A full set of coding must accompany these services to ensure complete reimbursement for these services rendered by healthcare providers. One of those codes is the CPT Code 99458, which specializes in telehealth and RPM. This article explains what CPT Code 99458 is, its requirements, billing guidelines, and how this code is being used in a medical practice.

What is CPT Code 99458?

CPT Code 99458 is part of the American Medical Association’s system for documenting and standardizing medical procedures and services. It is one of the Current Procedural Terminology (CPT) codes. For instance, this code refers to remote patient monitoring RPM services:

Remote patient monitoring (RPM) services, additional 20 minutes of care, provided by a healthcare professional, typically after the first 20 minutes of care, CPT 99457.

In plain language, CPT 99458 is a billing code representing the amount of time the provider has used to provide RPM services over the initial 20 minutes established under the guidelines provided by CPT Code 99457. An additional 20 minutes here means active participation of the healthcare provider to view the data, discuss it with the patient, and formulate a clinical judgment about the data obtained remotely.

What is Remote Patient Monitoring (RPM)?

The process of using digital technologies to capture health data from patients being observed at their homes and transfer this information to healthcare providers for tracking and decision-making on treatment is called remote patient monitoring. RPM is quite efficient in managing a chronic condition such as:

Hypertension
Diabetes
Asthma
Heart disease
Chronic Obstructive Pulmonary Disease (COPD)

Medical equipment such as a blood pressure cuff, glucose meter, scale, and pulse oximeter would allow healthcare professionals to remotely monitor home-based vital signs and other relevant health measurements from patients. Patients could be followed up more constantly, with improved outcomes, and hospital visits could also become less recurrent because they prove inconvenient for most patients and clinicians alike.

Essential Elements of CPT Code 99458

To properly use CPT Code 99458, healthcare providers must ensure that the service meets specific criteria. These criteria include:

1. The Patient’s Health Data Collection:

RPM services must be based on health data collected remotely, typically from devices that measure vital signs or chronic condition-specific metrics (e.g., blood sugar levels for diabetes).

2. Active Involvement by the Healthcare Provider:

The provider must take at least 20 more minutes to review the data, interpret the results, and discuss the findings with the patient. This can include calls, secure messaging, or video visits. The provider could also change treatment plans based on the data.

3. Patient Consent:

Patients must agree to remote monitoring. They should understand that their health data will be collected and reviewed by providers who are located remotely.

4. Data Transmission and Monitoring:

The data gathered has to be transmitted securely and HIPAA-compliantly to protect the patient’s identity.
This could involve electronic health record (EHR) systems, secure messaging apps, or specific RPM platforms.

5. Billing Requirements:

Code 99458 is billed only if more than 20 minutes of the RPM service. It is separately chargeable under code 99457. Code 99458 can be charged for every extra 20 minutes of RPM services.

Billing Guidance on CPT Code 99458

CPT Code 99458 is considered under the Medicare Physician Fee Schedule (MPFS) and would be covered under Medicare and by private insurance payers, with varying reimbursement.

1. Service Duration

The key billing requirement for CPT Code 99458 is the time the healthcare provider takes to review the data collected remotely, interpret it, and communicate with the patient. The service must be documented as lasting at least 20 minutes beyond the initial 20 minutes covered by CPT 99457.

2. Telemedicine & RPM Requirements:

Services covered by CPT Code 99458 can be rendered via telemedicine or direct communication tools, such as telephone calls, secure messages, or video consultations. Suppose the data is collected and transmitted to the healthcare provider asynchronously, such as a daily blood sugar log through a patient portal. The provider may still review the data and act appropriately in that case.

3. Services Included:

CPT Code 99458 includes a wide range of services, including:

The doctor must assess health statistics for a patient, observe them against acceptable values, and look for areas of anomaly.
Providers need to engage with patients in discussing conditions, revising treatment plans, or offering advice
The clinician needs to exercise clinical expertise as the provider adjusts medication or advises lifestyle changes based on facts collected.

4. Time management:

The time used towards CPT 99458 needs to be spent on clinical activities directly relevant to RPM. Such time cannot be calculated based on administrative activities such as scheduling or insurance verification.

When Can I Bill for CPT Code 99458?

You can only bill for CPT 99458 when these conditions are met:

CPT 99458 is an extension of CPT 99457, which covers the first 20 minutes of RPM. You cannot bill CPT 99458 without having previously billed CPT 99457.
The healthcare provider must keep detailed records of the time spent on RPM services. This includes documenting all interactions with the patient, time spent reviewing data, and any changes in the care plan.
RPM services under CPT 99458 are generally used for chronic conditions. Ensure that the diagnosis code (ICD-10) corresponds to the type of RPM services rendered.

Advantages of Using CPT Code 99458

The implementation and utilization of CPT 99458 have numerous benefits for healthcare providers and patients:

RPM enables healthcare providers to monitor patients continuously, leading to quicker interventions when necessary. It also allows for the detection of issues before they become emergencies.
Patients with chronic conditions can avoid frequent office visits and still receive continuous care. This reduces healthcare costs, travel time, and stress for patients.
With CPT 99458, providers can charge for extra time spent on RPM services. This will offset the cost of remote management of chronic conditions, but the patient's care is not compromised.
For chronic diseases such as diabetes and hypertension, where constant monitoring is required, remote patient monitoring offers better control, thus improving outcomes and possibly reducing hospitalizations.
With value-based care and chronic care management models being increasingly focused upon, telehealth and RPM services have become all the more relevant. Proper coding of these services using CPT 99458 helps providers ensure compliance with such regulations and fair reimbursement.

How Hello MDs Streamlines CPT Code 99458

Hello MDs streamlines CPT Code 99458 through a user-friendly platform that makes remote patient monitoring easy for healthcare providers. Hello MDs technology is secure and HIPAA-compliant, collecting patient data from wearable devices and sensors and automatically transmitting vital health metrics such as blood pressure, glucose levels, and heart rate.

Then, the healthcare provider can remotely access this information to assess the patient’s progress and even perform virtual consultations per CPT 99458 time and documentation requirements. Hello MDs reduce administrative burdens, ensure that extended RPM services are billed accurately, and increase the efficiency of chronic disease management to free up providers’ time to do what matters most: provide high-quality care.

Conclusion

CPT Code 99458 plays an essential role in RPM, which enables providers to charge for any additional 20 minutes of clinical time spent reviewing data and interacting with the patient. It has improved patient care through continuous monitoring, early intervention, and a decrease in the number of return-in-office visits. This code also helps providers offset some of the costs associated with managing chronic conditions in a remote capacity, leading to better patient outcomes. In cases when telemedicine progresses, CPT 99458 ensures accurate billing and abides by compliant and fair pay for RPM.

Frequently Asked Questions

How is CPT Code 99458 used?
CPT code 99458 is used as a bill when there are over 20 more minutes spent on performing remote patient monitoring services after completing the first set of 20 minutes, wherein patient data is examined, and there are clinical decision-making processes while communicating with patients.
Can CPT 99458 be billed separately from CPT 99457?
No, CPT 99458 cannot be submitted as an individual claim. Instead, it is an add-on code to CPT 99457 for the first 20 minutes of RPM services. The initial 20 minutes must be reported before CPT 99458 can be applied.
What services does CPT Code 99458 describe?
Reviewing the remotely collected health data, reviewing the patient's progression treatment adjustments, and communicating with the patient for calls or video consults under CPT 99458
Which devices are covered under remote patient monitoring using CPT 99458?
The common use of devices is usually by services provided in the form of measurement of vital health metrics. Blood pressure monitors, glucose meters, weight scales, pulse oximeters, etc.
How do Hello MDs make CPT Code 99458 easier?
Hello MDs simplifies CPT 99458 by automatically collecting data from wearable devices, sending it to the healthcare providers safely, and assisting with virtual visits, allowing for better chronic conditions management while keeping accurate billing.