CPT 99454 Description, Billing Rules, & Use Cases

CPT 99454 is used to report the monthly supply and transmission of a Remote Physiologic Monitoring (RPM) device. This code is time-dependent, requires consistent data capture, and must be tied to a physician-ordered monitoring plan.

​It does not include setup or patient onboarding (CPT 99453) or provider-led care management (CPT 99457/99458). Instead, it captures the passive, ongoing service layer that allows physiologic data to flow from the patient to the care team.

Patient Eligibility Criteria

To be eligible for RPM under CPT 99454, the patient must:

• Have a condition that warrants daily or near-daily physiologic monitoring
• Reside in a home or community-based setting (not a facility or hospital)
• Be enrolled in an active RPM program with physician oversight
• Be using a qualified, FDA-defined medical device capable of data transmission

RPM is commonly used for:

• Cardiovascular disease (e.g., hypertension, CHF)
• Diabetes management
• Respiratory illnesses (e.g., COPD, COVID-19 recovery)
• Weight and nutrition monitoring
• Post-surgical recovery or medication titration

Device and Setup Requirements

To qualify for 99454:

• The device must be FDA-defined as a medical device
• It must be capable of:
  • Measuring physiologic data (e.g., BP, glucose, weight, oximetry)
  • Automatically recording and transmitting data (manual entry is not allowed)
• The device must be supplied by the provider
• The patient must record data on ≥16 days within a 30-day period
• Data must be accessible and reviewed by the clinical team if alerts occur

Each billing cycle represents one calendar month, and multiple devices used concurrently for the same patient are not billed separately under 99454.

Who can Bill CPT 99453

CPT 99454 may be billed by:

• Physicians
• Nurse Practitioners (NPs)
• Physician Assistants (PAs)
• Other Qualified Healthcare Professionals (QHPs)

Device distribution and monitoring may be performed by clinical staff, but billing is tied to a supervising provider under general supervision.

Billing Frequency and Time Requirements

• CPT 99454 is billed once per 30-day period, per patient
• It requires at least 16 days of data transmission during that period
• Billing is only valid if the patient actively uses the device
• Reimbursement covers:​
  • Cellular or Bluetooth transmission
  • Portal/platform access
  • Data monitoring infrastructure
• The device lease or supply

CPT 99495 Billing Documentation Checklist

To support compliant billing of CPT 99454, include the following in the patient record:

• A documented provider order for RPM services:
  • Includes clinical rationale for physiologic monitoring
  • Specifies the type of data to be monitored (e.g., BP, weight, glucose)
• Description of the RPM device:
  • Meets the FDA definition of a medical device
  • Capable of automated data transmission (not manual logging)
  • Assigned to the patient for use in their home or community setting
• Device supply and activation record:
  • Date the device was provided to the patient
  • Documentation that the patient was onboarded and device functionality confirmed
  • Evidence that the system was connected to a clinical monitoring platform
• Transmission tracking for the billing cycle:
  • Confirmation that the patient transmitted data on at least 16 days in a 30-day period
  • Timeframe should match the billing period exactly
  • Optional: platform-generated logs or device usage summaries
• Patient participation verification:
  • Confirmation that the patient engaged with the device (passively or actively)
  • No extended gaps in measurement beyond allowable parameters
• Supervising provider identification:
  • The claim must be billed under a physician or QHP
  • Clinical staff involvement must occur under general supervision
• Attestation that:
  • The RPM service was not duplicated by another provider
  • Only one billing instance is submitted per 30-day cycle
  • Devices used concurrently for the same physiologic function are not billed separately