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See a sample rate comparisonCPT 99454 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Remote Monitoring, Remote Monitoring Of Physiologic Parameter(S) (Eg Weight Blood Pressure Pulse Oximetry Respiratory Flow Rate) Initial; Device(S) Supply With Daily Recording(S) Or Programmed Alert(S) Transmission 16-30 Days In A 30-Day Period Each 30 Days
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Special Evaluation and Management Services |
| Common Place of Service | 11 - Office |
| Common Modifiers | GW - Condition not related to the patient's terminal condition 95 - Telemedicine - audio and video |
| Complexity Level | Low |
| Medicare Fee Schedule | $52.11 national non-facility rate (2026) · View Medicare rates for 99454 |
| Medicaid Fee Schedule | $39.795 median of the 8 states in the free preview · View Medicaid rates for 99454 |
National average reimbursement for CPT 99454 by major payers:
$68.30
$76.83
$64.98
$95.63
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CPT 99454
5 of 25 sample ratesHigher to lower in this preview
Srishti Nangia
$208.89Published rateSyed Khan
Loyola University Medical Center
$115.72Published rateJonathan Kaplan
$104.73Published rateGhouse Mohiuddin
$72.84Published rateLucia Cuttone
Mochi Medical Nj PC
$29.78Published rate
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See a sample payer proposalCPT 99454 vs. Other Special Evaluation and Management Services Codes
The CPT 99454 code is part of the Evaluation and Management services used for Special Evaluation and Management Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99454 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99453-CPT | Low | Rem Mntr Physiol Param Setup, Remote Monitoring Of Physiologic Parameter S Eg Weight Blood Pressure Pulse Oximetry Respiratory Flow Rate Initial Set Up And Patient Education On Use Of Equipment |
| 99454-CPT | Low | Remote Monitoring, Remote Monitoring Of Physiologic Parameter(S) (Eg Weight Blood Pressure Pulse Oximetry Respiratory Flow Rate) Initial; Device(S) Supply With Daily Recording(S) Or Programmed Alert(S) Transmission 16-30 Days In A 30-Day Period Each 30 Days |
| 99457-CPT | Low | Rpm Tx Mgmt 1st 20 Min, Remote Physiologic Monitoring Treatment Management Services Clinical Staff/Physician/Other Qualified Health Care Professional Time In A Calendar Month Requiring 1 Real-Time Interactive Communication With The Patient/Caregiver During The Calendar Month; First 20 Minutes |
| 99458-CPT | Low | Rpm Tx Mgmt Ea Addl 20 Min, Remote Physiologic Monitoring Treatment Management Services Clinical Staff/Physician/Other Qualified Health Care Professional Time In A Calendar Month Requiring 1 Real-Time Interactive Communication With The Patient/Caregiver During The Calendar Month; Each Additional 20 Minutes (List Separately In Addition To Code For Primary Procedure) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99454. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99454 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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