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CPT 99457
Description, Billing Rules, and Use Cases

CPT 99457 is used to report the first 20 minutes of provider-led treatment management for Remote Physiologic Monitoring (RPM) or Remote Therapeutic Monitoring (RTM) services.

 

This time-based code reflects direct clinical involvement, including reviewing data, interacting with the patient, and updating care plans, and is billed once per calendar month when all criteria are met.

What is CPT Code 99457?

CPT 99457 covers the first 20 minutes of active care management delivered by a physician or qualified healthcare professional (QHP) for patients enrolled in RPM or RTM programs. This includes:

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  • Interpreting and analyzing transmitted physiologic or therapeutic data

  • Making clinical decisions based on trends or alerts

  • Conducting live, interactive communication with the patient or caregiver

  • Updating the care plan and documenting any interventions

 

CPT 99457 is not device-specific — it applies to either RPM (e.g., blood pressure cuffs, glucose meters) or RTM (e.g., musculoskeletal sensors, therapy adherence apps). It can only be billed once per patient per 30-day period, and it requires:

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  • ≥20 minutes of provider time

  • At least one real-time interactive communication

  • Direct or supervised clinical decision making

 

When care management exceeds 20 minutes, CPT 99458 may be billed for each additional 20-minute block.

CPT 99457 Billing Requirements and Eligibility

CPT 99457 is used to bill for remote treatment management services that include data review, care coordination, and direct communication between a patient and provider.

 

It is a time-based code, reported once per 30-day period, and reflects the first 20 minutes of active management under either RPM or RTM.

Patient Eligibility Criteria

To bill CPT 99457, the patient must:

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  • Be actively enrolled in a Remote Physiologic Monitoring (RPM) or Remote Therapeutic Monitoring (RTM) program

  • Use a qualified device capable of transmitting physiologic or therapeutic data

  • Have a documented condition for which remote management is clinically appropriate

  • Receive real-time interaction from a billing provider or QHP during the billing period

 

Typical use cases include:

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  • Hypertension, heart failure, and diabetes (RPM)

  • Chronic pain, COPD, MSK rehabilitation, or mental health (RTM)

  • Post-operative recovery or behavioral therapy adherence

Service and Time Requirements

CPT 99457 requires:

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  • At least 20 minutes of care management activity over a 30-day period

  • Work must be performed by a physician or QHP

  • Time must be documented in the EHR (cumulative or start/stop format)

  • A minimum of one interactive communication (e.g., phone or video call) with the patient or caregiver

 

Qualifying activities include:

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  • Reviewing transmitted data and alerts

  • Assessing symptom patterns or therapy response

  • Adjusting medications or care instructions

  • Providing education, coaching, or behavioral support

  • Coordinating with specialists or community services

Billing Frequency and Code Combinations

  • 99457 is billed once per calendar month, per patient

  • It may be combined with:

    • 99453 and 99454 (RPM setup + device supply)

    • 98975–98977 (RTM setup + supply)

    • 99458 for each additional 20-minute time block

  • It may not be reported more than once per month, and only one provider may bill per cycle

Who Can Bill CPT 99457?

This code must be:

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  • Personally provided by a physician or QHP

  • Supervised clinical staff time does not count toward the 20-minute threshold

  • The interactive communication must be conducted by the billing provider

 

CPT 99457 is not considered a face-to-face service, but it does require direct patient engagement, and all time-based components must be documented clearly.

CPT 99457 Billing Documentation Checklist

To compliantly bill CPT 99457, ensure the following details are recorded in the patient’s medical record:

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  • A valid provider order or care plan initiating RPM or RTM management

    • Includes clinical indication and monitoring goals

    • Identifies the device used and expected frequency of data transmission

  • Description of the device in use:

    • FDA-defined medical device (RPM) or therapeutic monitoring tool (RTM)

    • Configured for daily use and transmission

    • Supplied and monitored by the provider’s care team

  • Time tracking log for treatment management:

    • Total time spent by the billing provider or QHP (≥20 minutes)

    • Cumulative time or start/stop logs allowed

    • Time performed by clinical staff may not be included

  • Activity breakdown showing provider-led care:

    • Data interpretation and trend analysis

    • Adjustment of care plan or prescriptions

    • Patient education, coaching, or behavior review

    • Communication with specialists or other disciplines

  • Date and content of interactive communication with the patient:

    • Phone or video call (not automated messaging)

    • Summary of clinical discussion, findings, or instructions

    • Must occur within the same 30-day billing period

  • Provider credentials and attestation:

    • The service was personally performed by a physician or QHP

    • Documentation meets requirements for time and communication

    • No conflicting time-based codes were billed by other providers

  • Billing validation:

    • Only one provider billed 99457 during the cycle

    • 99458 (if reported) is supported by additional documented time blocks

CPT 99457 Time Thresholds and Code Combinations

CPT 99457 may be billed once per calendar month when a provider spends at least 20 minutes managing a patient’s care using RPM or RTM data. It also requires interactive communication and may be extended using CPT 99458 if time exceeds 20 minutes.

Table showing CPT 99457 billing rules based on provider time, interactive communication, and code pairing with 99458.

Important to Note:

  • Time must be personally spent by a physician or qualified healthcare professional (QHP)

  • Staff-only time does not count toward the threshold

  • A minimum of 20 minutes + live interaction must occur during the same billing month

  • CPT 99458 may only be used in addition to 99457

When to Use CPT 99457:
Common Scenarios and Use Cases

CPT 99457 is used when a provider or QHP delivers remote treatment management services for RPM or RTM, spending at least 20 minutes per month reviewing data, making decisions, and communicating with the patient.

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Here are examples of how CPT 99457 is used in practice:

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  • Ongoing RPM Support for Uncontrolled Hypertension
    A family medicine physician:

    • Reviews 3 weeks of elevated BP readings from a cellular device

    • Calls the patient to adjust medication and recommend dietary changes

    • Logs 22 minutes of care coordination and education
      Billing: 99457 (provider time + live communication completed)

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  • Monitoring Therapy Adherence with RTM MSK Sensor
    A physical medicine specialist:

    • Reviews motion sensor data showing poor exercise compliance

    • Conducts a phone consult to reinforce therapy goals and pain triggers

    • Adjusts the rehab protocol based on usage patterns
      Billing: 99457 (meets threshold for RTM treatment management)

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  • RPM Glucose Management for Type 2 Diabetes
    A primary care NP:

    • Interprets daily glucose trends over 28 days

    • Spends time updating care notes and adjusting insulin schedule

    • Conducts a video call to review progress and document understanding
      Billing: 99457 (RPM-focused care management + communication)

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  • Post-Operative Rehab Monitoring with RTM Device
    An orthopedic PA:

    • Reviews therapy adherence and symptom alerts

    • Logs 25 minutes of care coordination and intervention

    • Holds a secure message-based conversation with the patient
      Billing: 99457 (even with asynchronous tracking, live communication confirmed)

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Common CPT 99457 Billing Mistakes
(and How to Avoid Them)

CPT 99457 is often misused due to confusion around time tracking, supervision rules, and communication requirements. Below are common pitfalls and how to ensure compliance.

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  • ❌ Billing Without 20 Minutes of Documented Provider Time
    This code requires at least 20 minutes of care management performed by a physician or QHP. Time spent by staff cannot be counted toward the threshold.
     

  • ❌ No Interactive Communication Logged
    A real-time interaction (e.g., phone or video call) with the patient or caregiver must occur during the 30-day period. Asynchronous messages or portal notes alone do not qualify.
     

  • ❌ Time Aggregated Across Multiple Providers or Patients
    99457 is per patient, per provider, per month. Time spent across unrelated tasks or other patients cannot be pooled to meet the threshold.​​
     

  • ❌ Misuse of CPT 99458 Without Meeting 99457 First
    CPT 99458 is an add-on code and cannot be billed unless CPT 99457 was reported in the same billing period.
     

  • ❌ Missing or Incomplete Documentation
    ​Auditable records must include:

    • Time tracking (cumulative or start/stop)

    • Nature of services performed

    • Date and details of the interactive communication

    • Provider credentials

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