Medicare RPM Billing: CPT 99453 99454 99457

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The short version
in 60 seconds.

Here's what happens when a patient walks into your urgent care and you use MyPulseScan. No jargon — just what happens and what you get paid.

The Patient Walks In

Your staff types their name + birthday. That's it.

No clipboard. No 4-page form. No “can you spell that?” In under 30 seconds, MyPulseScan pulls their full medical history — allergies, medications, past diagnoses, recent labs — from Epic, Apple Health, and 320M+ US patient records. The provider walks in already knowing who they're treating.

What your staff actually does

✓

Type patient first name, last name, and date of birth

✓

Hit search — complete record appears in under 30 seconds

✓

Provider reviews the summary before entering the room

This Is the Part Most Clinics Don't Know About

The government has a billing code for exactly what you just did.

When you digitally collect and review a patient's health data — which is exactly what MyPulseScan does — Medicare has specific billing codes for that. They're called Remote Patient Monitoring codes, or RPM. They exist because Congress decided in 2019 that digital health data collection should be reimbursed just like any other clinical service. Most urgent cares have never billed a single one.

🏛 These codes have existed since 2019. Most urgent cares leave this money on the table every single month.

The First Check

Every new patient = $20. One time. Medicare pays it.

The first time a patient uses MyPulseScan at your clinic, you can bill this code. Medicare pays you — not the patient — just for enrolling them in digital monitoring.

CPT 99453One-time per patient

“Initial setup and patient education on remote monitoring.”
Translation: You used a digital tool to pull their health data for the first time. That qualifies.

Medicare pays you

$20

per patient, one time

Patient owes

Medicare covers it

100 new patients/yr

$2,000

just from this code

💳Who pays: Medicare Part B covers 80%. Secondary insurance covers the other 20%. Most patients owe $0.

The Monthly Check — This Is Where It Gets Good

For patients who come back: $47 every single month.

For patients with chronic conditions — diabetes, hypertension, heart disease — who return regularly, you can bill this code every month as long as MyPulseScan is monitoring their data.

CPT 99454Every 30 days

“Monthly device supply with daily data transmission.”
Translation: MyPulseScan continuously monitors this patient's health data. Ongoing digital monitoring = this code.

Medicare pays you

$47

per patient, per month

Per year per patient

$564

annually recurring

Requirement

16 days

of data per month

📅Fine print: Requires 16 days of patient data per 30-day period. MyPulseScan's continuous monitoring handles this automatically.

One More Monthly Code

Add $48 more when the provider reviews the data.

When your provider reviews a patient's MyPulseScan summary and spends at least 20 minutes during the month interacting with the patient about their health data — that's this code.

CPT 99457Every calendar month

“Remote monitoring treatment management — 20 minutes of provider time.”
Translation: Your provider reviewed the patient's digital record and talked to them for 20 minutes this month. That's already happening. Now it pays extra.

Medicare pays you

$48

per patient, per month

Per year per patient

$576

annually recurring

Requirement

20 min

provider time/month

The Punchline

Stack 99454 + 99457 on the same patient. That's $95/month.

For any patient with a chronic condition, bill both codes in the same month. $47 for data monitoring + $48 for provider review = $95 per patient per month from Medicare. Every month. Without changing a single thing about how you practice.

CPT 99454

$47

data monitoring

CPT 99457

$48

provider review

Monthly per patient

$95

recurring revenue

12 months

$1,140

per patient per year

Real Examples

Two patients. Two different checks.

Not every patient generates the same revenue. Here's exactly what your billing looks like for the two most common visit types.

One-Time / Acute Visit

Maria G.

Sprained ankle. First visit. Probably won't be back. Typical urgent care walk-in.

99453First-time digital setup$20

99454Monthly monitoring — N/A—

99457Provider review — N/A—

Medicare pays you$20

One time only. At 60 new walk-ins a month: $1,200/month just from first-visit codes.

Recurring / Chronic Patient

Robert T.

Type 2 diabetic. Comes in monthly. Hypertension. Medicare Part B.

99453First-time setup (month 1 only)+$20

99454Monthly data monitoring$47/mo

99457Provider review (20 min)$48/mo

Medicare pays you$95/mo

Month after month. $1,140/year from this one patient. You have dozens of Roberts.

What This Looks Like

Here's the actual Medicare reimbursement for a 100-patient practice.

Medicare / Insurance Reimbursement

Remote Patient Monitoring — Monthly Payment

RPM-2026-0042

Pay To The Order Of

Your Urgent Care Practice

For: Remote Patient Monitoring services — CPT 99453, 99454, 99457 — 100 patients, April 2026

Amount

$2,900

per month · 100 patients

Funding Source

Medicare Part B (80%)
Secondary Insurance (20%)

Where that $2,900 comes from: 60 one-time patients × $20 = $1,200 + 40 recurring patients × $47 = $1,880 + 40 recurring patients × $48 = $1,920. Conservative 40% recurring rate. The number grows every month as your recurring base builds.

The Bottom Line

Here's what hits your bank
at every patient volume.

Urgent care numbers assume 40% of patients have recurring conditions — conservative for most walk-in practices.

Annual RPM Revenue vs. Platform Cost

40% recurring rate · Growth tier · $250 base + $5/patient

RPM Revenue
Monthly from Medicare

$3,800

CPT 99453 + 99454 + 99457

Staff Time Saved
Value per Month

$1,320

6 min/patient × $22/hr

MyPulseScan Cost
Per Month

-$750

$250 + $5/patient

Your Net Gain
This Year

$52,440

407% monthly ROI

Run Your Numbers

Everything updates in real time

Live

Monthly patients100

% Qualify for RPM50%

% Recurring patients40%

99453 — First-visit billings/mo$600

99454 — Monthly monitoring/mo$940

99457 — Provider review/mo$960

Staff time recovered/yr (6 min/pt)$2,640

MyPulseScan monthly cost-$899

Net annual gain for your clinic$21,852

Monthly ROI on platform cost: 178%

Based on 2025–2026 Medicare Physician Fee Schedule national averages. Actual reimbursement varies by payer, region, and eligibility. RPM billing requires a licensed NPI. Consult your billing department. Staff savings modeled at $22/hr, 6 min/patient.

Medicare will literally
pay for this.

The short version
in 60 seconds.

Your staff types their name + birthday. That's it.

The government has a billing code for exactly what you just did.

Every new patient = $20. One time. Medicare pays it.

For patients who come back: $47 every single month.

Add $48 more when the provider reviews the data.

Stack 99454 + 99457 on the same patient. That's $95/month.

Two patients. Two different checks.

Here's the actual Medicare reimbursement for a 100-patient practice.

Here's what hits your bank
at every patient volume.

Stop leaving free money behind.

Medicare will literallypay for this.

The short versionin 60 seconds.

Your staff types their name + birthday. That's it.

The government has a billing code for exactly what you just did.

Every new patient = $20. One time. Medicare pays it.

For patients who come back: $47 every single month.

Add $48 more when the provider reviews the data.

Stack 99454 + 99457 on the same patient. That's $95/month.

Two patients. Two different checks.

Here's the actual Medicare reimbursement for a 100-patient practice.

Here's what hits your bankat every patient volume.

Stop leaving free money behind.

Medicare will literally
pay for this.

The short version
in 60 seconds.

Here's what hits your bank
at every patient volume.