CPT 99457: Remote Physiologic Monitoring Treatment Management
99457 reports the first 20 minutes of remote physiologic monitoring treatment management in a calendar month, with at least one live interactive communication with the patient or caregiver. For 2026 CMS added a 10 minute code beside it, 99470, so the month's minutes now pick between the two.
Written by Salman Saeed, CEO and Co-Founder · Reviewed by a Certified Medical Coder · Last reviewed October 2026In short: 99457 is a monthly time code for RPM treatment management: 20 minutes with one live communication. For 2026, 99470 covers the first 10 minutes, and 99457 and 99470 are not billed together.
What Does CPT 99457 Report?
99457 is the monthly treatment management code for remote physiologic monitoring (RPM). It covers the first 20 minutes a practitioner or clinical staff spend in a calendar month on the patient's transmitted data and plan of care, with at least one live, interactive communication with the patient or caregiver. The CMS fee schedule file labels it "Rpm tx mgmt 1st 20 min".
| Item | Value in the file |
|---|---|
| Payment status | A (active code) |
| Work RVU | 0.61 |
| Non-facility total RVU | 1.55 |
| Facility total RVU | 0.79 |
| Global period | XXX |
| MUE | 1 per date of service, adjudication indicator 2 (policy) |
In the CY 2026 final rule CMS kept the work RVU at 0.61, rejecting the RUC recommendation of 0.45 (90 FR 49398).
What Changed for Remote Monitoring Codes in 2026?
For 2026 CMS adopted two new RPM codes: 99445 for 2 to 15 days of data in a 30 day period, and 99470 for the first 10 minutes of treatment management. 99454 now specifies 16 to 30 days. 99457 itself is unchanged.
| Code | CMS short label | Role |
|---|---|---|
| 99453 | Rem mntr physiol param setup | Setup and patient education |
| 99445 | Rem mntr physiol param 2-15 | Device supply, 2 to 15 days of data |
| 99454 | Rem mntr physiol param 16-30 | Device supply, 16 to 30 days of data |
| 99470 | Rpm tx mgmt 1st 10 min | Treatment management, first 10 minutes |
| 99457 | Rpm tx mgmt 1st 20 min | Treatment management, first 20 minutes |
| 99458 | Rpm tx mgmt ea addl 20 min | Add-on for each further 20 minutes |
CMS explained that the two device codes are not additive, so you bill one of them. The 10 minute code (99470) and the 20 minute code (99457) are also not additive: choose the one that fits the month's time, and add 99458 after 99457 when more than 20 additional minutes are needed.
How Are the 20 Minutes Counted?
The 20 minutes are total treatment management time in the calendar month, and one live interactive communication is required. In the CY 2026 final rule CMS adopted the CPT language that the interactive communication contributes to the total time but does not have to account for all of it.
CMS set no further exclusions on the kind of communication if it meets the CPT specifications, and for in-clinic discussions no time may be counted twice.
A nurse spends 14 minutes on readings and the plan, and the practitioner spends 7 minutes on a call with the patient. The 21 minutes include one live communication, so the month supports 99457.
What Must Be True Before You Bill 99457?
- The patient is an established patient. MLN901705 requires an established patient relationship for RPM, but not for remote therapeutic monitoring.
- The monitored condition is acute or chronic, the monitoring is medically necessary, and consent is obtained when the service is provided.
- Data are collected electronically and uploaded automatically to a secure location, using a device that meets the FDA definition of a medical device.
- Only E/M-eligible practitioners bill RPM, one practitioner per patient in a 30 day period, and RPM cannot be billed together with remote therapeutic monitoring.
The days-of-data rule does not apply to 99457, and auxiliary personnel can provide the service under general supervision. RPM can run alongside CCM or TCM if no time is counted twice.
How Does 99457 Appear on the Claim?
On the CMS-1500, Item 24D carries 99457, Item 24G carries 1 unit and Item 24E points to the monitored condition. 99457 is not on the CMS telehealth services list for 2026, so no telehealth modifier is used.
Home health agencies report remote monitoring with HCPCS G0322 on type of bill 032x, with the start date and the number of days in the units field, per MLN901705. See home health billing.
What Fields Hold the Remote Monitoring Month?
The first 20 minutes of monitoring management is one line, 99457 in Item 24D with 1 unit in Item 24G and a pointer in Item 24E to the condition being monitored. The add-on for further time goes on its own line.
RVU26D gives 99457 status A, global XXX, and the MUE table allows 1 per date with indicator 2, a policy edit.
Example: A patient with high blood pressure uses a cuff and the nurse spends 22 minutes on review and a call by 10/28. The line is 99457, pointer A (I10), 1 unit. A 99457 line for a month with only 15 minutes is unsupported, since 99470 fits that month, and may be denied under CO-151.
Why Is 99457 Denied?
| Code | What X12 says | What usually causes it |
|---|---|---|
| CO-151 | Information does not support this many or this frequency of services | A second practitioner billed RPM for the same patient and period |
| CO-97 | The benefit is included in the payment for another service already adjudicated | 99457 and 99470 on the same patient in one month |
| CO-50 | Not deemed a medical necessity by the payer | Condition not acute or chronic, or no care plan change |
| CO-16 | Claim lacks information or has a billing error | No consent, or minutes not shown in the record |
If these denials keep coming back, our denial management team can work them. For the monthly care management code, see 99490.
Related Codes
- Physician Fee Schedule relative value files, RVU26D (October 2026) · CMS
- Medicare NCCI Medically Unlikely Edits, practitioner services table, effective 10-01-2026 · CMS
- Medicare Claims Processing Manual, Chapter 26: Completing and Processing Form CMS-1500 Data Set · CMS
- Claim Adjustment Reason Codes · X12
- Telehealth & Remote Monitoring (MLN901705, December 2025) · CMS
- CY 2026 Physician Fee Schedule final rule (90 FR 49266) · Federal Register
- List of Telehealth Services for Calendar Year 2026 · CMS
We check every rule, code and deadline against the official source. See our editorial policy.
Common Questions
Straight answers from the team that does the work.
Ask a billing lead directly. A 20-minute call, Monday to Friday, 9am to 5pm Eastern.
01How many minutes are needed for 99457 remote monitoring?
99457 needs 20 minutes of treatment management time in the calendar month, with at least one live interactive communication with the patient or caregiver. If the month's time falls short of 20 minutes, 99470 for the first 10 minutes is the code to consider, and 99458 adds each further 20 minutes.
02Does 99457 require 16 days of data?
No. MLN901705 says the 2 to 15 or 16 or more days of data rule does not apply to the treatment management codes, 99457 and 99458. It applies to the device supply codes, 99445 for 2 to 15 days and 99454 for 16 to 30 days.
03Can I bill 99457 and 99470 in the same month?
No. CMS explained in the CY 2026 final rule that the first 10 minute code (99470) and first 20 minute code (99457) are not additive. You choose the one that fits the time spent that calendar month, and 99458 can follow 99457 for more time.
04Does the interactive communication need to last the whole 20 minutes?
No. CMS adopted the CPT language that a live, interactive communication contributes to total time but does not have to equal the whole reported time. The other minutes can be data review and care plan work, as long as no time is counted twice for any service.
05Can a new patient receive remote physiologic monitoring?
Not for Medicare billing. MLN901705 states that remote physiologic monitoring requires an established patient relationship, unlike remote therapeutic monitoring. A new patient therefore needs a visit with the billing practitioner before RPM, including 99457, can be billed for them. Consent is then taken when the service is provided.
06Is 99457 a Medicare telehealth service?
No. 99457 does not appear on the CY 2026 CMS list of Medicare telehealth services, so no telehealth modifier applies. MLN901705 covers remote monitoring in a separate section from telehealth visits and describes it as monitoring done with a connected device that transmits the data to the provider.
RPM Minutes Not Reaching the Claim?
We check the monthly time log, the device codes and the one-practitioner rule before the claim goes out.