CPT 99458
Description, Billing Rules, and Use Cases

CPT 99458 Billing Requirements and Eligibility

CPT 99458 is a time-based add-on code used to extend reimbursement when a provider delivers more than 20 minutes of remote care management under RPM or RTM in a 30-day period. It cannot be billed on its own — it must always follow a claim for CPT 99457.

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This code allows physicians and QHPs to be reimbursed for additional, medically necessary time, provided it’s properly tracked and documented.

Patient Eligibility Criteria

The patient must:

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• Be enrolled in a qualified RPM or RTM program

• Be actively using a transmitting medical or therapeutic device

• Have data and care complexity that justify extended management time

• Receive ongoing treatment management from the billing provider or QHP

99458 is most often used when:

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• A patient has high-risk or unstable clinical status

• There are frequent data anomalies or symptom reports

• Medication or therapy adjustments require multiple touchpoints

• Multiple communication sessions occur during a single billing cycle

Service and Time Requirements

To bill CPT 99458:

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• The first 20 minutes must be reported with CPT 99457

• Each additional 20-minute increment may be reported with a unit of 99458

• Time must be:

  • Personally performed by a physician or QHP

  • Distinct from CPT 99457

  • Cumulative, with exact time tracked and documented

Qualifying activities include:

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• Data review and clinical interpretation

• Symptom or trend analysis

• Additional interactive communication

• Patient education, behavioral coaching, or lifestyle planning

• Coordination with external care providers

Billing Frequency and Code Combinations

• CPT 99458 may be billed multiple times per 30-day cycle as justified

• It must follow a 99457 claim for the same billing period

• May be combined with:

  • RPM setup and supply (99453, 99454)

  • RTM setup and supply (98975–98977)

• Only one provider group may bill per patient per month

Who Can Bill CPT 99458?

CPT 99458 must be:

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• Personally delivered by a physician or QHP

• Staff-only time is not billable under this code

• The total time must be distinct from general care coordination or messaging

CPT 99458 Billing Documentation Checklist

To support proper billing of CPT 99458, the following must be documented in the patient’s medical record:

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• A previously billed CPT 99457 for the same 30-day period:

  • 99458 may not be reported alone

  • Must clearly follow an eligible treatment management cycle

• Cumulative time tracking for each 20-minute increment beyond 99457:

  • Personally performed by the physician or QHP

  • May be tracked using cumulative logs or start/stop time documentation

  • Clearly separated from non-billable administrative or clinical staff activity

• Description of billable care management services performed:

  • Interpretation of transmitted physiologic or therapeutic data

  • Communication of findings to the patient or caregiver

  • Modification of the treatment or monitoring plan

  • Care team coordination or patient behavioral coaching

• Documentation of interactive communication (if applicable to the additional time):

  • Date, format (phone, video), and content summary

  • Must reflect clinical relevance and time contribution

• Provider credentials and attestation:

  • Billing provider must be a physician, NP, PA, or QHP

  • Time billed under 99458 must be distinct and additive beyond the initial 20 minutes reported under 99457

• Billing limits and claim consistency:

  • Only one provider or group may bill for RPM/RTM management during a 30-day cycle

  • 99458 units reflect medically necessary extended care, not routine data monitoring