CPT 99453 Description, Billing Rules, & Use Cases

CPT 99453 is used to report the initial setup and patient education for a Remote Physiological Monitoring (RPM) device. This code applies once per episode of care when a qualified device is provided and the patient is instructed on proper use.

It supports clinical programs that rely on home-based data collection for physiologic indicators such as blood pressure, weight, or heart rate.

What is CPT Code 99453?

CPT 99453 covers the initial setup and patient onboarding for a device used in an RPM program.

This includes:

Setting up the monitoring equipment
Configuring and activating the device for patient-specific use
Training the patient or caregiver on how to operate the device correctly
Educating the patient on how data will be collected and transmitted

CPT 99453 is billed once per episode of care (not monthly) and may only be reported when data is collected for at least 16 days in a 30-day period (usually reported alongside CPT 99454).

To qualify for billing:

The device must meet the FDA definition of a medical device
The setup and education must be personally supervised by the billing provider or their clinical team
The service must be separately documented in the medical record

This code is foundational to initiating RPM programs and is typically used when launching monitoring for conditions such as hypertension, heart failure, diabetes, or obesity.

CPT 99453 Time Thresholds and Code Combinations

CPT 99453 is a one-time setup code and may only be reported when specific time and data criteria are met during the initial RPM episode. It is not billed monthly and should not be used for ongoing device supply or treatment management.

Important to Note:

CPT 99453 may only be billed once per patient per episode if:

A qualified RPM device is supplied and configured
The patient or caregiver receives documented onboarding and education
16 or more days of valid data are recorded within the 30-day period
Setup was performed under appropriate supervision and is clearly documented

Table showing billing logic for CPT 99453 based on setup timing, data thresholds, and code combinations for RPM.

When to Use CPT 99495: Common Scenarios and Use Cases

CPT 99453 should be reported when a provider or supervised care team supplies, configures, and educates a patient on the use of a qualifying Remote Physiologic Monitoring (RPM) device. It is used once per episode and must be supported by device use and clinical documentation.

Here are examples of how CPT 99453 is used in practice:

Onboarding for Hypertension Management

Post-Discharge Monitoring for Heart Failure Symptoms

Setup for a Glucose Monitoring Program

Onboarding an RPM Program for Hypertension Management

A primary care provider:

Supplies an FDA-approved blood pressure cuff with auto-transmission
Ensures the patient is trained on daily measurement procedures
Confirms data collection begins and logs readings for 17 days

Billing: 99453 (once per RPM setup with education and data threshold met)

Female doctor recording blood pressure reading for young woman during routine checkup, illustrating preventive care and vital sign monitoring in primary care settings

Post-Discharge Monitoring for Heart Failure Symptoms

A cardiology NP:

Provides a digital weight scale to monitor fluid retention trends
Trains the patient’s spouse on how to sync and use the app
Documents patient education and device activation

Billing: 99453 (RPM episode initiated and supported by 16+ days of data)

Patient using digital blood pressure monitor at home as part of chronic care management (CCM) services under CPT 99490, tracking systolic, diastolic, and pulse data for care coordination.

Initial Setup for a Diabetic Glucose Monitoring Program

A care team nurse (under supervision):

Activates a connected glucose meter for home monitoring
Teaches the patient how to check and transmit readings daily
Notes that the patient transmitted 20 days of data in the first month

Billing: 99453 (qualifies for one-time setup code)

Patient preparing medication dose at home during Chronic Care Management session

CPT 99453 Billing Requirements and Eligibility

CPT 99453 is used to report the initial setup and onboarding of a Remote Physiologic Monitoring (RPM) device. It is billed once per episode of care, and only when setup and education services are actually performed and documented.

This code does not cover device transmission, data collection, or treatment management — those services are billed separately (e.g., CPT 99454, 99457).

Patient Eligibility Criteria

To be eligible for RPM under CPT 99453, the patient must:

Have a clinical condition that warrants ongoing physiologic monitoring
Be discharged to or reside in a home or community setting (not a hospital or SNF)
Provide informed consent to participate in the RPM program
Be capable of using the monitoring device independently or with assistance

RPM is most commonly used to manage:

Hypertension and cardiovascular conditions
Diabetes and metabolic syndromes
Chronic respiratory diseases (e.g., COPD)
Obesity and post-acute surgical follow-up

Device and Setup Requirements

The device supplied must:

Be defined by the FDA as a medical device
Automatically record and transmit physiologic data (e.g., heart rate, blood pressure, weight, glucose)
Be configured for patient-specific use and support daily measurement
Support automated or passive transmission (manual entry generally does not qualify)

Setup and onboarding must include:

Assignment and activation of the device
Instruction on correct usage, frequency of measurement, and transmission expectations
Documentation of patient or caregiver education

Who can Bill CPT 99453

CPT 99453 may be billed by:

Clinical staff under general supervision may perform the service, but billing must be tied to a supervising provider.

Billing Frequency and Time Requirements

CPT 99453 is billed once per device setup per episode of care
It may only be reported if the patient records data on ≥16 days within the 30-day RPM period
It should not be reported more than once per patient per condition unless a new episode begins and documentation supports re-setup

This code is typically billed at the start of an RPM program, in conjunction with CPT 99454 for device supply and data transmission.

CPT 99495 Billing Documentation Checklist

To support compliant billing of CPT 99453, ensure the following elements are documented in the patient record:

A provider order or care plan authorizing initiation of RPM services
Patient consent for enrollment in the RPM program:
- Verbal or written
- Notation that the patient agrees to use the device and understands its purpose
Description of the device supplied:
- FDA-defined as a medical device
- Assigned to the patient for physiologic monitoring
- Capable of automatic or passive data transmission
Documentation of setup and configuration:
- Date the device was supplied and activated
- Name and role of the person performing setup
- Confirmation that the device was linked to a monitoring platform or system
Education and onboarding notes:
- Patient or caregiver instruction on device use and measurement process
- Review of daily use expectations and troubleshooting
- Confirmation that the patient was successfully onboarded and demonstrated understanding
Confirmation that the patient:
- Used the device to record and transmit data
- Recorded at least 16 days of readings within a 30-day period
Supervising provider name and credentials:
- Billing provider must be a physician or QHP
- Setup may be performed by clinical staff under general supervision
Statement that this is a first-time setup for this episode of care:
- No prior billing of 99453 for the same patient/device unless a new episode was initiated

Common CPT 99453 Billing Mistakes (and How to Avoid Them)

❌ Billing Without Documented Setup or Education

CPT 99453 requires clear documentation of device configuration and patient or caregiver training. If setup is not performed — or not recorded — the code is not valid.

❌ Fewer Than 16 Days of Data Collected

Even if setup is completed, CPT 99453 may not be reported unless 16 or more days of physiologic data are recorded within the same 30-day period.

❌ Repeated Billing Without a New Episode of Care

99453 is a one-time code per episode. It cannot be billed monthly or reused unless the patient starts a distinct new RPM program with updated documentation.

❌ Using Non-Compliant or Manual Entry Devices

Devices must meet the FDA definition of a medical device and be capable of automated transmission. Devices that rely on manual logging generally do not qualify.

❌ Unsupervised Setup by Staff

While clinical staff may perform setup and education, the service must be billed under general supervision by a physician or QHP. Staff-only billing is not allowed.