Reimbursement
$51.77
Threshold
20m
2026 Status
Active
What is CPT Code 99457?
CPT 99457 is defined as: Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.
This code is primarily used for RPM services. It falls under the category of Remote Patient Monitoring (RPM) and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
0.61
Physician Effort
PE (Non-Fac)
0.9
Practice Expense
Malpractice
0.04
Risk Factor
Total RVU
1.55
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
efficiency shield
Strategically exempt from the -2.5% productivity adjustment (Time-based care management service).
fqhc rhc transition
FQHCs must now itemize and bill 99457 for 20 minutes of professional RPM management following G0511 sunset.
conversion factor benefit
As a protected service, 99457 retains its full RVU value while procedural units face valuation compression.
Administrative Framework
Place of Service
Key Modifiers
Operational Requirements
minimum time
20 minutes of cumulative clinical time per calendar month.
interactive requirement
Must include at least one synchronous (live) interaction via phone or video with the patient or caregiver.
staff type
Clinical staff under general supervision or QHP.
billing unit
Once per calendar month.
Compliance Checklist
Audit Defense
interaction stamp
The mere review of data is insufficient. Audit failure occurs if the 20-minute log does not contain a specific entry for the 'patient phone/video call'.
no overlap
Ensure time spent on CCM (99490) or PCM (99424) for the same patient is tracked separately and does not overlap with 99457.
2026 Update
Asynchronous messaging (e.g., patient portal texts) does NOT satisfy the 'interactive communication' requirement unless coupled with a synchronous call.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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