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Reimbursement information

A shift towards prevention

Remote patient monitoring CPT® codes provide a foundation for a DFU prevention program. With the Cost category accounting for 15% of your MIPS score, embracing prevention takes on added importance.

U.S. CPT® code considerations*

CPT® 99453

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment.

Billing Frequency
One time only; requires 16 days of data in 30 day period
CPT® 99454

Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days.

Billing Frequency
One time per 30 day period
CPT® 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.

Billing Frequency
First 20 minutes of RPM services, including one interactive communication, per calendar month
CPT® 99458

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; each additional 20 minutes (list separately in addition to code for primary procedure).

Billing Frequency
For each additional 20 minutes of RPM services, per calendar month
HCPCS A5514

For diabetics only, multiple density insert, made by direct carving with CAM technology from a rectified CAD model created from a digitized scan of the patient, total contact with patient's foot, including arch, base layer minimum of 3/16 inch material of shore a 35 durometer (or higher), includes arch filler and other shaping material, custom fabricated, each.

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Canadian Reimbursement

Public System Payment

  • The province of Alberta has dedicated, temporary codes and reimbursement for Orpyx SI sensory insoles
  • For patients in other provinces, insoles are available as an out-of-pocket purchase

Private Insurance Supported

  • Most supplemental policies pay up to C$500 per year for custom insoles with a physician’s prescription

Contact an Orpyx representative

*The reimbursement information provided is intended to provide general information concerning coding of Orpyx products only. Orpyx does not guarantee coverage or payment for any products. The ultimate responsibility for proper coding, satisfying reimbursement requirements, and obtaining reimbursement remains with the provider. Coding and coverage policies and guidelines are complex, can vary from one carrier or region to another, and are updated frequently. Providers should check with their local carriers or intermediaries often and should consult with counsel, a reimbursement specialist for coding, coverage, or billing questions. Current Procedural Terminology (CPT®) is copyright by the American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA). CPT codes and their descriptions do not reflect or guarantee coverage or payment.