CPT 99474E&M

Self-meas bp 2 readg bid 30d

CPT code 99474 covers the professional review and analysis of patient self-measured blood pressure readings taken twice daily for 30 days. This code reimburses the physician for interpreting the patient-collected home blood pressure data and using it to guide treatment decisions.

Showing rates for

National Average

Base Medicare rate

$16.50

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

0.18

PE RVU (NF)

0.32

MP RVU

0.01

Total RVU

0.51

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

NCCI bundling edits

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Billing tips

Bill 99474 only once per 30-day period regardless of how many times data is reviewed
Impact: Prevents automatic denials and recoupment; duplicate billing within 30 days results in 100% denial of second claim
Ensure patient has collected minimum 12 readings over 30 days with at least 2 readings on most days before billing
Impact: Insufficient readings trigger medical necessity denials; proper documentation supports full $16.50 reimbursement
Document the specific blood pressure device make/model and confirm FDA validation or clinical accuracy standards
Impact: Device validation documentation reduces audit risk and supports medical necessity; lack of device documentation is top audit finding
Provide patient with written instructions and obtain consent for remote monitoring before the 30-day period begins
Impact: CMS requires documented patient education and consent; missing consent documentation can result in full claim denial
Do not bill 99474 with 99453, 99454, or 99091 for the same monitoring period
Impact: These codes are bundled/mutually exclusive; concurrent billing results in denial of all codes submitted, losing $16.50-$60+ in revenue
Bill under the facility rate ($8.41) when patient is in a hospital outpatient department or on-campus provider-based setting
Impact: Incorrect place of service coding results in $8.09 overpayment and potential audit recoupment with interest

Common denials

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Frequently asked questions

What is CPT code 99474 used for?

CPT 99474 is used to bill for physician review and interpretation of patient self-measured blood pressure data collected at home over a 30-day period. The patient must take at least 2 readings per day for 30 days, and the physician reviews this data to guide hypertension treatment decisions.

How much does Medicare pay for CPT 99474 in 2025?

Medicare pays $16.50 for CPT 99474 in the non-facility (office) setting and $8.41 in the facility setting based on the 2025 Physician Fee Schedule. The total RVU is 0.51 with a conversion factor of 32.3465.

How often can you bill CPT 99474?

CPT 99474 can only be billed once per 30-day monitoring period. You cannot bill it multiple times within the same 30-day period, even if you review the data multiple times. After completing one 30-day cycle, you may begin a new monitoring period if medically necessary.

What documentation is required to bill CPT 99474?

Required documentation includes: evidence of at least 12 BP readings over 30 days, patient consent for monitoring, validated BP device information, physician's written interpretation of the data, clinical findings based on BP trends, and treatment plan modifications. The physician must personally review and document their analysis.

Can CPT 99474 be billed with an office visit?

Yes, CPT 99474 can be billed on the same date as an E/M office visit (99202-99215) if the services are separate and distinct. The blood pressure review represents a separate service from the face-to-face encounter. Consider using modifier XE if payer requires documentation of separate encounter.

What blood pressure devices qualify for CPT 99474?

The blood pressure device must be validated for clinical accuracy. FDA-cleared automated oscillometric devices are preferred. Document the device make, model, and validation status. Devices should meet ISO standards or be listed in validated device registries. Manual sphygmomanometers may be used if properly validated.

Can CPT 99474 be billed with other remote monitoring codes?

No, CPT 99474 should not be billed concurrently with CPT 99453, 99454, or 99091 for the same monitoring period as these represent overlapping services. However, 99474 may be appropriate with separate chronic care management (99490, 99491) or principal care management codes if documentation supports distinct services.