CPT 99458
Global ZZZ ActiveRpm tx mgmt ea addl 20 min
CPT 99458 Billing & Documentation Guide
CPT code 99458 (Rpm tx mgmt ea addl 20 min) is classified under E/M with a global period indicator of ZZZ. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 0.61, a non-facility practice expense RVU of 0.59, and a malpractice RVU of 0.04, a total non-facility RVU of 1.24 and facility RVU of 0.79. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $42.5, though rates vary from $37.99 to $52.29 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99458, 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 99458 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
Add-on code (global concept does not apply)
MUE Limit (Medically Unlikely Edits)
Submitting more than 3 units of 99458 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 99458
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 0.61 | 0.61 |
| Practice Expense RVU | 0.59 | 0.14 |
| Malpractice RVU | 0.04 | 0.04 |
| Total RVU | 1.24 | 0.79 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99458
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 | $45.15 | $27.36 | $43.04 - $51.75 | 29 |
| Florida | $42.75 | $27.67 | $41.22 - $44.27 | 3 |
| Georgia | $40.81 | $26.47 | $39.55 - $42.06 | 2 |
| Illinois | $42.04 | $27.52 | $40.45 - $43.39 | 4 |
| Michigan | $40.75 | $26.65 | $39.87 - $41.64 | 2 |
| North Carolina | $39.61 | $25.59 | $39.61 - $39.61 | 1 |
| New York | $45.14 | $28.37 | $40.03 - $47.59 | 5 |
| Ohio | $39.71 | $25.99 | $39.71 - $39.71 | 1 |
| Pennsylvania | $41.29 | $26.56 | $39.73 - $42.85 | 2 |
| Texas | $41.13 | $26.33 | $39.55 - $42.45 | 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 99458
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99458 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 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 |
| 96523 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 97750 | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 97750 | Column 1 (primary), can be billed with modifier | 9 | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99458
What does CPT code 99458 mean? +
CPT code 99458 represents: Rpm tx mgmt ea addl 20 min. It's in the E/M category with a global period of ZZZ.
What is the Medicare reimbursement for CPT 99458? +
The 2026 Medicare national average non-facility payment for CPT 99458 is $42.5. Rates range from $37.99 to $52.29 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99458? +
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 99458? +
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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