CPT 99457 covers the first 20 minutes of remote monitoring treatment management in a calendar month. Two things make it payable: documented time and a real conversation with the patient, and for 2026 there is a shorter-duration alternative when the time falls short.
What CPT 99457 covers
99457 is remote physiologic monitoring treatment management services, clinical staff, physician or other qualified health care professional time in a calendar month requiring interactive communication with the patient or caregiver during the month, first 20 minutes.
The interactive communication is not optional and not satisfied by reviewing data. It means a real-time exchange with the patient or caregiver during the month being billed.
How the RPM family fits together
Remote physiologic monitoring bills in two halves: getting the device running and doing something with the data.
- 99453: initial set-up and patient education on use of the equipment. Once per episode of care.
- 99454: device supply with daily recordings or programmed alert transmissions, each 30 days. Requires at least 16 days of data in the 30-day period.
- 99445 (new for 2026): the same device supply for a 2 to 15 day window in a 30-day period, for patients whose clinically appropriate monitoring is shorter.
- 99457: treatment management, first 20 minutes in a calendar month, requiring at least one real-time interactive communication with the patient or caregiver.
- 99470 (new for 2026): treatment management, first 10 minutes in a calendar month, for months that do not reach the 20-minute threshold. Still requires the interactive communication.
- 99458: each additional 20 minutes of treatment management.
Check before billing 99457
- The management minutes are documented, and time spent by clinical staff meets the applicable supervision requirements.
- Only one practitioner reports RPM for the patient in the period.
- The data being managed comes from an FDA-defined device with automatic upload, not patient self-report.
See the family-wide RPM rules on the CPT 99454 guide.
Reimbursement context
2026 Medicare RVUs for CPT 99457
| CPT 99457: 2026 Medicare RVUs (national, before GPCI) | ||||||
|---|---|---|---|---|---|---|
| Line | Work | PE, non-facility | PE, facility | Malpractice | Total, non-facility | Total, facility |
| Global (no modifier) | 0.61 | 0.90 | 0.14 | 0.04 | 1.55 | 0.79 |
Source: CMS CY 2026 PFS Relative Value File, RVU26D (October release, published 08/26/2026). RVUs are national and unadjusted; commercial payers set their own rates.
In the 2026 CMS relative value file, CPT 99457 carries 0.61 work RVUs, with 1.55 total RVUs in a non-facility setting and 0.79 in a facility. The gap is practice expense: the office carries it in one setting and the facility in the other. Its PC/TC indicator is 0: CMS treats it as a physician service, so modifiers 26 and TC do not apply in any setting. Its global indicator is XXX: the surgical global period concept does not apply.
To turn RVUs into payment, each component is multiplied by your locality's geographic practice cost index, the three are added, and the sum is multiplied by the 2026 conversion factor: $33.4009, or $33.5675 for qualifying APM participants (CMS-1832-F; CMS fact sheet). The CMS Physician Fee Schedule Look-Up Tool runs that calculation for your locality.
Documentation requirements
- The order for remote monitoring and the patient's consent, dated before monitoring began.
- The condition being monitored and why remote monitoring is clinically appropriate.
- The device used, and that it meets the medical device definition.
- The number of days data was transmitted in the period, since the day count drives code selection.
- For management codes, the time spent and the date and nature of the interactive communication.
- The clinical decisions made in response to the data.
- A record that no other practitioner is billing RPM for this patient in the period.
Common denials and the exact fix
No interactive communication documented
The most common 99457 denial and the hardest to appeal. Data review alone, however thorough, does not meet the requirement.
Fix: record the date, the participants and the nature of the real-time contact every month. A template field forces this better than a narrative habit.
Time short of 20 minutes
Nineteen minutes has historically been unbillable.
Fix: for 2026 dates of service, report 99470 where management reached at least 10 minutes but not 20. Do not round time up to reach a threshold, which is the pattern audits look for.
Time not documented
A claim asserting 20 minutes with no time record behind it will not survive review.
Fix: capture start and stop or total minutes contemporaneously, tied to the specific activities performed.
Billed on a 30-day period instead of a calendar month
The management codes run on the calendar month, unlike the device supply code.
Fix: separate the two clocks in the billing system.
Clinical staff time billed without meeting supervision rules
Where staff time is counted, the applicable supervision requirement has to be satisfied.
Fix: confirm the supervision arrangement for the setting before counting staff time.
Modifier rules
- 25: on a same-day E/M where a separately identifiable service was provided beyond the monitoring, never on the 99457 line.
- 95 / telehealth modifiers: 99457 is not a telehealth service and does not generally take a telehealth modifier. Check payer instruction rather than assuming.
- 26 / TC: not used. CMS gives 99457 a PC/TC indicator of 0.
- Add-on companion: 99457 is the primary code that 99458 attaches to; 99458 carries no modifier 51.
NCCI bundling edits
- 99457 with 99458: 99458 is the add-on for each additional 20 minutes and requires 99457 on the claim.
- 99457 with 99470: report the code matching the time actually documented, not both.
- 99457 with 99454 or 99445: separately reportable. Management and supply are different services.
- 99457 with a same-day E/M: time counted toward the E/M cannot also be counted toward the monitoring management.
- 99457 with the cardiac device monitoring codes: different family.
Frequently asked questions
Does reviewing the data count toward CPT 99457?
What if management time is under 20 minutes?
Does 99457 run on a calendar month or a 30-day period?
Can clinical staff time be counted?
Sources
American Medical Association, CPT 2026 Professional Edition.
Centers for Medicare & Medicaid Services, CY 2026 PFS Relative Value File RVU26D (October release): RVUs, PC/TC indicator and global period for CPT 99457.
Centers for Medicare & Medicaid Services, CY 2026 Physician Fee Schedule final rule, CMS-1832-F: conversion factors.
Centers for Medicare & Medicaid Services, National Correct Coding Initiative Policy Manual for Medicare Services and quarterly procedure-to-procedure edit tables.
CY 2026 PFS final rule, CMS-1832-F: remote physiologic monitoring provisions.
CPT® is a registered trademark of the American Medical Association. Payer policy and NCCI edits change quarterly, so check your own contractor before submission. How we verify this guidance.
Related codes
- CPT 99458. RPM management, each added 20 minutes.
- CPT 99454. RPM device supply, 16 or more days of data.
- CPT 99453. RPM setup and patient education.
More cardiology code guides
- CPT 93784. 24-hour ambulatory blood pressure monitoring.
Related reading
- Cardiology billing & RCM. How we scrub cardiology claims across diagnostics, cath lab, EP and remote monitoring.
- Cardiac RPM billing compliance. Transmission windows, documentation and the rules that trip up remote monitoring claims.
- TC/26 modifier errors in cardiology. The split-billing mistakes that cost diagnostic practices the most.
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