Wiki 99457 RPM codes

[mrsrobinson525]

I'm billing RPM codes for the first time and I need some guidance.
I've read the code description from the 2024 CPT book stating "Interactive live communication with patient at least 20 minutes per month."
I also read an article from Optimize Health stating:
"What Activities Contribute to Clinical Monitoring? In general, any time spent monitoring patient data or communicating with patients about their health can count toward 99457. All activities need to be documented.
They include:

• Monitoring and analyzing patient data
• Sending any patient communication (for example, text or phone)
• Providing ongoing patient education or communicating patient updates and patient escalations
• Reviewing a patient’s readings with other members of the care team
• Making changes to a patient’s care plan or medications"

I understand the time it takes to complete these tasks should be counted, but as I read the actual code description, I think they should be completing a 20 minute call or video in addition to these tasks.
Is this correct?
We have a third party biller documenting RPM. They documented 15 minutes of monitoring and only a 5 minute phone call for the month.
Is this billable?
My thought is no, but perhaps I'm misunderstanding the guidelines.
Any help or resources would be most appreciated!
TSM

 

[rthomas@impcna.com]

I'm billing RPM codes for the first time and I need some guidance.
I've read the code description from the 2024 CPT book stating "Interactive live communication with patient at least 20 minutes per month."
I also read an article from Optimize Health stating:
"What Activities Contribute to Clinical Monitoring? In general, any time spent monitoring patient data or communicating with patients about their health can count toward 99457. All activities need to be documented.
They include:

• Monitoring and analyzing patient data
• Sending any patient communication (for example, text or phone)
• Providing ongoing patient education or communicating patient updates and patient escalations
• Reviewing a patient’s readings with other members of the care team
• Making changes to a patient’s care plan or medications"

I understand the time it takes to complete these tasks should be counted, but as I read the actual code description, I think they should be completing a 20 minute call or video in addition to these tasks.
Is this correct?
We have a third party biller documenting RPM. They documented 15 minutes of monitoring and only a 5 minute phone call for the month.
Is this billable?
My thought is no, but perhaps I'm misunderstanding the guidelines.
Any help or resources would be most appreciated!
TSM

We have been doing RPM for over a year now. We previously used Optimize Health as our platform and now use CareMatix. For 99457 you do not have to have a 20-minute phone or video call. You just have to have made contact via phone, even if it is just a 2 min call making sure everything is going OK.