top of page

CPT 99454
Description, Billing Rules, and Use Cases

CPT 99454 is used to report the monthly supply, transmission, and monitoring of Remote Physiologic Monitoring (RPM) devices.

 

This code supports care programs that depend on patient-generated data collected outside the clinic, such as blood pressure, glucose, weight, or pulse oximetry, and enables providers to receive reimbursement for connected care infrastructure.

What is CPT Code 99454?

CPT 99454 covers the ongoing supply and management of a physiologic monitoring device used in a Remote Physiologic Monitoring (RPM) program. It is billed once per 30-day period, as long as:

​

  • A qualified device is supplied to the patient

  • The device is capable of automatic data transmission

  • The system captures and transmits patient data on at least 16 days within the 30-day period

 

This code does not include setup or patient education (reported under CPT 99453), nor does it cover treatment management time (reported under CPT 99457 or 99458). Instead, CPT 99454 represents the passive data infrastructure that powers RPM — including cellular connectivity, portal access, and monitoring alerts.

​

It applies to chronic and acute physiologic monitoring use cases such as:

​

  • Hypertension

  • Heart failure

  • Diabetes

  • Obesity

  • COPD and post-discharge recovery

CPT 99454 Billing Requirements and Eligibility

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 Transmission 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.

Billing Frequency and Timing 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

Who Can Bill CPT 99454?

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.

CPT 99454 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

CPT 99454 Time Thresholds and Code Combinations

CPT 99454 may be billed once per calendar month to report the supply and transmission of a physiologic monitoring device. Providers must confirm both technical compliance and patient engagement before submitting the claim.

Table showing CPT 99454 billing scenarios based on device usage, data days, code combinations, and monthly limits.

Important to Note:

CPT 99454 requires:

​

  • An FDA-defined device assigned to the patient

  • Device use that results in ≥16 days of data transmission

  • A single billing instance per 30-day period, per patient

  • Supervised infrastructure with accessible review capabilities

When to Use CPT 99454:
Common Scenarios and Use Cases

CPT 99454 is used to report the monthly device supply and data transmission component of a Remote Physiologic Monitoring (RPM) program. It applies once per 30-day period when the device is used on at least 16 days, and transmission occurs as expected.

​

Here are examples of how CPT 99454 is used in practice:

​​​

  • Monthly RPM Monitoring for Hypertension
    A primary care provider:

    • Assigns a cellular blood pressure cuff to a patient with uncontrolled hypertension

    • Data is automatically transmitted and stored in a monitoring platform

    • The patient uses the device consistently over 21 days
      Billing: 99454 (one unit for monthly supply and data transmission)

​

  • Post-Cardiac Event Monitoring Using RPM Scale
    A cardiology NP:

    • Provides a connected weight scale to monitor for fluid retention in a CHF patient

    • The patient transmits data on 18 of 30 days

    • The scale is integrated with the team’s monitoring dashboard
      Billing: 99453 (RPM episode initiated and supported by 16+ days of data)

​

  • Diabetes Management with Connected Glucose Meter
    A family medicine physician:

    • Supplies a Bluetooth-enabled glucose meter to track fasting glucose

    • Data is transmitted passively via mobile app sync

    • Staff confirms daily use over 20 days and logs device compliance
      Billing: 99454 (valid for monthly monitoring period)

​

  • Weight Monitoring for Bariatric Surgery Recovery
    An obesity medicine specialist:

    • Assigns a digital RPM scale for post-op weight tracking

    • Ensures patient uses the device consistently over a 30-day period

    • Portal shows 17 logged days with no transmission gaps
      Billing: 99454 (one monthly charge with device engagement confirmed)

​​​

Common CPT 99454 Billing Mistakes
(and How to Avoid Them)

Because CPT 99454 is billed monthly, it’s often misunderstood or overused. Accurate documentation and timing are critical to avoid denials or audit issues.

​

  • ❌ Fewer Than 16 Days of Data Transmission
    The most common mistake is billing 99454 when the patient uses the device for less than 16 days. Even if the device was supplied and setup occurred, the code may not be reported.
     

  • ❌ Manually Entered Data from Non-Qualified Devices
    CPT 99454 requires automated transmission from an FDA-defined medical device. Readings entered manually by the patient or caregiver do not qualify for billing.
     

  • ❌ Duplicate Billing Within the Same 30-Day Period
    Only one unit of 99454 may be billed per patient per 30-day cycle. Do not submit multiple claims for different devices or split coverage across multiple providers.​​
     

  • ❌ Device Not Supplied by the Billing Provider
    The device must be furnished by the billing provider or their care team. RPM platforms that do not document this connection can lead to rejected claims.
     

  • ❌ Missing Documentation of Transmission or Platform Integration
    Ensure there is documentation — preferably system-generated — showing that the device:

    • Was in use

    • Transmitted data

    • Met the required number of days

    • Was linked to the provider’s monitoring workflow

bottom of page