Remote physiologic monitoring treatment management services, clinical staff/physician time in a calendar month requiring interactive communication, first 20 minutes
Audit Defense & Denial Intelligence
Research-based denial patterns from OrbDoc Bill Analyzer
1. 20-minute treatment management time not met
Very Common99457 requires at least 20 minutes of interactive communication with patient for treatment management based on RPM data. Time not meeting 20 minutes or not documented triggers denial.
Common Causes
- • Time log shows <20 minutes
- • No documentation of interactive communication
- • Automated alerts reviewed but no patient interaction
Resolution Strategy
Provide time log showing 20+ minutes of interactive treatment management (discussing data with patient, adjusting treatment plan, addressing concerns). Must be documented contemporaneously.
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Frequently Asked Questions
CPT 99457 is the billing code for "Remote physiologic monitoring treatment management services, clinical staff/physician time in a calendar month requiring interactive communication, first 20 minutes". It falls under the Care Management category and is used by healthcare providers to bill insurance for this specific service.
Medicare pays approximately $47.87 for CPT 99457 (national average). Actual payment varies by geographic location due to GPCI adjustments. Hospital and commercial insurance rates are typically 2-4x higher than Medicare rates.
The most common denial reason for CPT 99457 is "20-minute treatment management time not met". 99457 requires at least 20 minutes of interactive communication with patient for treatment management based on RPM data. Time not meeting 20 minutes or not documented triggers denial. Common causes include: Time log shows <20 minutes; No documentation of interactive communication. Appeal success rate is approximately 40-60%.