CPT 99458E&M

Rem physiol mntr ea addl 20

CPT code 99458 is used when a healthcare provider spends additional time (beyond the first 20 minutes) remotely monitoring and managing a patient's health data collected by devices like blood pressure monitors, glucose meters, or weight scales. Each unit of 99458 represents an additional 20 minutes of provider time.

Showing rates for

National Average

Base Medicare rate

$38.49

This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.

RVU breakdown

Work RVU

0.61

PE RVU (NF)

0.54

MP RVU

0.04

Total RVU

1.19

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact time spent in interactive communication for each 20-minute increment. Bill one unit of 99458 for each additional 20 minutes beyond the first 20 covered by 99457.
Impact: Each documented 20-minute increment yields $38.49 (non-facility). Billing 2 units of 99458 with one 99457 (60 minutes total) generates approximately $115 vs $76 for just 99457 alone—a $39 increase per patient per month.
99458 can only be billed with 99457 in the same calendar month. Ensure 99457 requirements are met (minimum 20 minutes) before billing any units of 99458.
Impact: Prevents immediate denial; 99458 without 99457 will reject 100% of the time as it is an add-on code
Time spent in interactive communication does not need to be continuous; aggregate all qualifying time throughout the calendar month and bill appropriate units.
Impact: Maximizes reimbursement by capturing all qualifying time; three 15-minute calls (45 total minutes) supports 99457 + one 99458 unit for $76.98 total vs just $38.49 if only base code billed
Interactive communication includes live video, telephone, or real-time audio-video interaction; review of data without patient interaction does not count toward time for 99458.
Impact: Ensures compliance and reduces audit risk; non-interactive time is not billable and could trigger recoupment if documented as billable time
Bill 99458 only once per calendar month per patient unless you have documented at least 40 minutes of total interactive time (20 for 99457 + 20 for 99458); for 60+ minutes, bill 99457 + 2 units of 99458.
Impact: Each additional unit generates $38.49; 80 minutes of documented time = 99457 + 3 units of 99458 = $154.47 monthly revenue per patient

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Frequently asked questions

How much does Medicare pay for CPT code 99458 in 2025?

Medicare pays $38.49 for CPT 99458 in the non-facility (office) setting and $28.79 in the facility setting based on the 2025 national average payment rates. Actual reimbursement may vary by geographic locality due to practice expense and malpractice adjustments.

How many times can you bill 99458 per patient per month?

You can bill 99458 multiple times per patient per month, with each unit representing an additional 20 minutes of interactive communication beyond the first 20 minutes covered by 99457. For example, 60 minutes of total interactive time would support 99457 plus two units of 99458. There is no specific CMS limit on the number of units per month as long as the time is documented and medically necessary.

Can 99458 be billed alone without 99457?

No, CPT 99458 is an add-on code and cannot be billed alone. It must always be reported with the primary code 99457 in the same calendar month. Billing 99458 without 99457 will result in claim denial.

What counts as interactive communication time for CPT 99458?

Interactive communication includes real-time telephone calls, video visits, or synchronous audio-video interactions between the healthcare provider (or qualified clinical staff) and the patient. The time must involve treatment management activities such as medication adjustments, symptom review, care coordination, or clinical decision-making based on remotely transmitted data. Automated messages, emails without real-time response, or provider time reviewing data without patient interaction do not count.

What is the difference between 99457 and 99458?

CPT 99457 is the base code covering the first 20 minutes of interactive communication for remote physiologic monitoring treatment management services in a calendar month. CPT 99458 is the add-on code for each additional 20 minutes beyond the first 20. You must bill 99457 first; 99458 captures extended time increments.

Do I need to use modifier 95 when billing 99458 for telehealth?

Modifier 95 is not universally required for 99458 as it is inherently a remote service code. However, some commercial payers may require modifier 95 when the interactive communication occurs via synchronous telehealth. Check individual payer policies. Medicare does not require modifier 95 for 99458 as of 2025.

How do I document time for multiple short calls to support billing 99458?

Time for 99458 (and 99457) is cumulative throughout the calendar month. Document each interactive communication session separately with the date, start and stop times (or total duration), and clinical content. At month-end, total all qualifying interactive communication minutes. If you have 40+ total minutes, you can bill 99457 (first 20 minutes) plus one unit of 99458 (additional 20 minutes). Maintain a monthly time log as audit-ready documentation.