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RPM · 2026 Medicare final

CPT 99457: RPM treatment management, first 20 minutes

CPT 99457 is the Medicare RPM code for treatment management, first 20 minutes. The CY2026 national non-facility rate is $51.77. A 99457 claim must pass 4 checks under the CY2026 Medicare final rule; each is below with its source.

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CPT 99457 documentation checklist

Why 99457 claims get stopped

  • 19 minutesRepair
  • Minutes logged in two months are not addedHold
  • Portal messages onlyRepair
  • Note says call, time log says voicemailExpert review
  • No consent on fileRepair
  • Consent dated after the first serviceHold
  • Consent on file without a dateExpert review
  • No visit on fileHold

  1. 01 · RPM-MGMT-01 · in force from 2026-01-01

    20 or more minutes of management in the calendar month

    Minutes
    ≥ 20 in the calendar month
    “…time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes.”
    CMS PFS CY2024 final, 88 FR 78882

    Examples

    • 24 minutes across 5 entriesReady
    • 19 minutesRepair
    • Minutes logged in two months are not addedHold

  2. 02 · RPM-MGMT-03 · in force from 2026-01-01

    At least one live, interactive communication with the patient in the month

    “…require a live, interactive communication with the patient/caregiver. The interactive communication contributes to the total time, but it does not need to represent the entire cumulative reported time.”
    CMS PFS CY2026 final, 90 FR 49397

    Examples

    • One 11-minute phone callReady
    • Video visit countsReady
    • Portal messages onlyRepair
    • Note says call, time log says voicemailExpert review

  3. 03 · RPM-CONS-01 · in force from 2021-01-01

    Patient consent on file, at the latest when the first service is furnished

    “…allow consent to be obtained at the time that RPM services are furnished.”
    CMS PFS CY2021 final, 85 FR 84544 · MLN901705 p. 13

    Examples

    • Signed consent dated before the first readingReady
    • Verbal consent in a note with date and staffReady
    • No consent on fileRepair
    • Consent dated after the first serviceHold
    • Consent on file without a dateExpert review

  4. 04 · RPM-EST-01 · in force from 2023-05-12

    Established patient before monitoring starts

    “RPM, not RTM, services require an established patient relationship after the end of the PHE.”
    CMS PFS CY2024 final, 88 FR 78884

    Examples

    • Office visit in the prior 3 yearsReady
    • No visit on fileHold

Related RPM codes

This page explains Medicare rules; it is not legal or billing advice. Rates are CY2026 national non-facility amounts; your MAC's locality rates differ.