Reimbursement
$41.42
Threshold
20m
2026 Status
Active
What is CPT Code 99458?
CPT 99458 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; each additional 20 minutes (List separately in addition to code for primary procedure).
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)
0.59
Practice Expense
Malpractice
0.04
Risk Factor
Total RVU
1.24
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
threshold reduction
CMS 2026 officially reduced the additional time threshold to 10 minutes (previously interpreted as 20 min in some proposals), allowing for tighter revenue capture.
efficiency shield
Protected from the -2.5% productivity adjustment (Time-based care management service).
revenue impact
Providers can now capture revenue for 30 minutes of care (99457 + 99458) which was previously often lost or unbillable in 20-minute buckets.
Administrative Framework
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
Each additional 10 minutes (Threshold starts at 30, 40, 50... minutes).
primary code
99457 (Must be billed for the first 20 minutes).
staff type
Clinical staff or QHP under supervision.
stacking rule
Can be billed with multiple units for each additional 10-minute block.
Compliance Checklist
Audit Defense
minute by minute log
Audit logs must show incremental accumulation of time. Vague statements like 'spent extra time' will result in recoupment.
active management
Each 10-minute block must represent active clinical effort (reviewing, coordinating, communicating), not just passive wait time.
2026 Update
The shift from 20-minute to 10-minute add-ons represents a major documentation shift. Billing systems must be updated to trigger at the 30-minute mark.
Common Clinical Scenarios
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Frequently Asked Questions
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