CPT 99457
Global XXX ActiveRpm tx mgmt 1st 20 min
CPT 99457 Billing & Documentation Guide
CPT code 99457 (Rpm tx mgmt 1st 20 min) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.61, a non-facility practice expense RVU of 0.9, and a malpractice RVU of 0.04, a total non-facility RVU of 1.55 and facility RVU of 0.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $53.31, though rates vary from $46.88 to $66.68 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99457, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99457 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99457 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99457
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.61 | 0.61 |
| Practice Expense RVU | 0.9 | 0.14 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 1.55 | 0.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99457
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $57.4 | $27.36 | $54.38 - $66.68 | 29 |
| Florida | $53.14 | $27.67 | $51.12 - $55.05 | 3 |
| Georgia | $50.68 | $26.47 | $48.78 - $52.58 | 2 |
| Illinois | $52.04 | $27.52 | $49.91 - $53.79 | 4 |
| Michigan | $50.49 | $26.65 | $49.33 - $51.64 | 2 |
| North Carolina | $49.28 | $25.59 | $49.28 - $49.28 | 1 |
| New York | $56.69 | $28.37 | $49.87 - $59.9 | 5 |
| Ohio | $49.17 | $25.99 | $49.17 - $49.17 | 1 |
| Pennsylvania | $51.43 | $26.56 | $49.23 - $53.63 | 2 |
| Texas | $51.32 | $26.33 | $48.97 - $53.4 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99457
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99457 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0206T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0578T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 0734T | Column 1 (primary), can be billed with modifier | Yes | Mutually exclusive procedures |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93294 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93295 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93297 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93298 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 93793 | Column 1 (primary), can be billed with modifier | Yes | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99457
What does CPT code 99457 mean? +
CPT code 99457 represents: Rpm tx mgmt 1st 20 min. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99457? +
The 2026 Medicare national average non-facility payment for CPT 99457 is $53.31. Rates range from $46.88 to $66.68 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99457? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99457? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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