Starting January 1, 2025, New York State (NYS) Medicaid will reimburse for CPT code 99457, marking a significant step forward in expanding access to Remote Patient Monitoring (RPM) services. This change reflects growing recognition of RPM’s role in managing chronic conditions and supporting vulnerable populations, especially when delivered by clinical staff under supervision of a physician or qualified healthcare professional.
This blog breaks down what CPT 99457 is, what the NYS Medicaid Telehealth Policy Manual says, and what it means for providers, patients, and innovators in digital health to meet this policy shift head-on.
What the NYS Medicaid Manual Says—Verbatim
In the updated NYS Medicaid Telehealth Policy Manual (December 2024), Section 9.8 titled “Billing for Remote Patient Monitoring” includes the following new language:
“Effective January 1, 2025, NYS Medicaid will reimburse RPM Current Procedural Terminology (CPT) code ‘99457’. Medicaid Managed Care (MMC) Plans must comply with this coverage, by March 1, 2025.”
The policy also clarifies that:
“This service may be delivered by clinical staff; however, the service must be ordered by a physician or other qualified health care professional. Clinical staff includes individuals under the direction of a physician or qualified health care professional who do not independently bill professional services, such as pharmacists and some registered dieticians.”
Further, the policy states:
“Providers delivering RPM must confirm that they operate within their scope of practice. Clinical staff may not order nor modify prescriptions. This service is not intended for retail pharmacists.”
And finally, it specifies:
“CPT code ‘99457’ requires a live, interactive communication with the patient/caregiver. The interactive communication contributes to the cumulative time, but it does not need to represent the entire cumulative reported time of the treatment management services. Providers are not to bill ‘99457’ more than one time per member per 30-day period.”
What This Means
CPT 99457 is a billing code that lets physicians and qualified professionals get reimbursed for treatment management services related to RPM. But here’s what’s new and important:
- Clinical staff can now deliver RPM services under supervision.
- These services can now be reimbursed by NYS Medicaid, as long as certain conditions are met.
- It requires interactive communication—which means a real-time phone or video conversation—with the patient or caregiver at least once per month.
- Only one billing per member per 30-day period is allowed.
- The policy is effective for Fee-for-Service (FFS) Medicaid starting January 1, 2025, and for Managed Care Plans by March 1, 2025.
Reimbursement Rate and Requirements
According to the Medicaid Telehealth Manual:
“99457 – Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes… $41.80”
To bill for this code:
- The service must be ordered by a physician, nurse practitioner, or other qualified health care provider.
- The device used for monitoring must be FDA-cleared (or approved, as applicable).
- The provider must document patient consent and their clinical interpretation of the collected data.
Why This Matters: Expanding Access Through RPM
By reimbursing CPT 99457, NYS Medicaid is doing more than just ticking off a code; it is acknowledging the clinical and cost-saving potential of RPM when performed not just by doctors, but also by pharmacists, registered dieticians, and other clinical staff.
This move:
- Supports early intervention for patients with chronic diseases like diabetes, COPD, and heart failure.
- Reduces unnecessary hospitalizations and emergency room visits.
- Promotes health equity, especially for patients in rural or underserved areas.
- Encourages providers to adopt digital tools for proactive care management.
And let’s not forget the policy’s commitment to quality:
“Providers delivering RPM must confirm that they operate within their scope of practice.”
That line ensures that RPM remains clinically sound, and that supervision stays within the framework of professional accountability.
Where Does CPT 99457 Fit in the Broader RPM Ecosystem?
NYS Medicaid has long covered RPM through codes like 99091, which is reserved for physicians or qualified health care professionals and includes tasks like data review and care plan modification. But until now, there was no Medicaid reimbursement for the clinical staff’s role in RPM treatment management.
CPT 99457 fills that gap. It’s designed for ongoing monthly management, where a nurse, pharmacist, or other clinical staff member (under supervision) helps guide the patient based on biometric data from devices.
It’s an especially timely policy update as RPM tools become more sophisticated—and more essential.
A Note on Devices and Setup Codes
RPM services must be supported by FDA-defined medical devices. That means consumer-grade fitness trackers won’t qualify. The devices must:
- Record vital parameters (e.g., blood pressure, glucose, oxygen saturation)
- Transmit data electronically
- Allow for clinical interpretation
Other RPM-related codes include:
- 99453 – One-time setup and patient education
- 99454 – Monthly device supply and data transmission
- 99091 – Data review by physician (still reimbursed)
- 99457 – Treatment management by clinical staff (newly reimbursed)
Codes 99453 and 99454 are already reimbursed by NYS Medicaid—particularly for maternal services using the “HD” modifier. CPT 99457 completes the trio by reimbursing the time spent managing the data and engaging with patients.
Use Cases: Who Benefits from This?
The December 2024 Manual lists conditions suitable for RPM, including:
“Congestive heart failure, diabetes, chronic obstructive pulmonary disease (COPD), wound care, polypharmacy, mental or behavioral problems, and technology-dependent care such as continuous oxygen, ventilator care, total parenteral nutrition, or enteral feeding.”
These patients often require close monitoring but may not always need to travel for in-person care. With 99457 in play, providers can offer more accessible, lower-cost, and continuous care—with Medicaid backing them financially.
How DrKumo Supports This New Medicaid Direction
DrKumo is uniquely positioned to meet NYS Medicaid’s newly expanded RPM billing framework. As a cybersecurity-first remote patient monitoring platform, DrKumo offers:
- FDA-listed medical devices for health vitals like blood pressure, blood glucose, and oxygen saturation.
- Secure, HIPAA-compliant software aligned with federal frameworks like FIPS 140-3, VA Directive 6500, and NIST.
- AI/ML-powered data analytics, providing real-time alerts and actionable insights.
- Patient engagement tools including live clinical staff communication—qualifying for CPT 99457.
- Turnkey reimbursement support, including documentation assistance, patient consent capture, and compliance alerts.
DrKumo’s platform is designed to support operational workflows that align with NYS Medicaid requirements, enabling staff to operate within scope while preserving supervising provider oversight.
It’s not just about ticking boxes. DrKumo helps transform compliance into care that actually works for patients, especially veterans, FQHC patients, and Medicaid populations.
Why NYS Medicaid’s Policy Shift Matters for the Nation
New York State’s move to reimburse CPT 99457 could set a precedent for other states still on the fence about expanding RPM coverage. It mirrors national trends but stands out for two reasons:
- Explicit allowance for clinical staff involvement in RPM management.
- Tight integration with Managed Care Plans, requiring adoption by March 1, 2025.
As other state Medicaid programs look to modernize care delivery, New York’s Telehealth Policy Manual could become a national reference point.
Takeaways
Starting January 1, 2025, New York State Medicaid will begin reimbursing for CPT 99457, enabling physicians and their clinical staff to deliver and bill for RPM treatment management services. To qualify, the service must include a live, interactive communication with the patient or caregiver at least once per month, use an FDA-listed medical device, and be ordered by a licensed physician or qualified health care professional. Providers must document patient consent and ensure all services are delivered within the appropriate scope of practice.
DrKumo’s AI-driven RPM platform is fully aligned with these Medicaid requirements and offers a secure, turnkey solution for compliant, reimbursable RPM services.
Explore how DrKumo can help your practice seamlessly implement RPM for Medicaid patients, or contact us today to see how our platform supports CPT 99457 billing and patient engagement workflows.
Disclaimer: This blog is for informational purposes only and does not constitute legal, billing, or clinical advice. Providers should refer directly to the NYS Medicaid Telehealth Policy Manual (Updated December 2024) for official guidance and consult their billing or compliance departments for specific implementation.
