CPT code 99242: Office consultation, straightforward level2026 Medicare rate & RVUs in Missouri
Office or outpatient consultation for a requested clinical opinion at the straightforward level, for a new or established patient.
CMS doesn’t publish an office rate for 99242 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99242 covers
Code 99242 identifies an office or other outpatient consultation for a new or established patient at the straightforward medical decision-making level. A physician or other qualified health care professional evaluates the patient in response to a request for an opinion or advice on a clinical question and communicates the assessment to the requester. The code carries a 20-minute time designation.
Medicare lists 99242 as status I: it is not valid for Medicare, which uses a different code to report and pay for the service. The 20-minute designation identifies the consultation service level; it does not make 99242 a Medicare-valid reporting code. The consultation family distinguishes outpatient consultations from inpatient or observation consultations and from ordinary office or outpatient E/M visits.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99242 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | Unavailable |
| Metropolitan St. Louis, MO | Unavailable | Unavailable |
| Rest of Missouri | Unavailable | Unavailable |
How the 99242 rate is calculated
Each of 99242’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99242
RVUs × geographic indexes × conversion factor
Work1.08
1.08 RVUs× 1.000 GPCI
Practice expense1.10
1.10 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
2.2500
Conversion factor
$33.4009
Medicare rate
$75.15
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99242
99242 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99242
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99242 isn’t priced in this setting.
99242 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99243Office consultationLow MDM, 30 minutes
- Both are office or outpatient consultations. 99242 has straightforward decision-making and a 20-minute designation; 99243 has low decision-making complexity and a 30-minute designation.
- 99245Office consultationHigh level, 55 minutes
- 99245 is a higher outpatient consultation level, with high decision-making complexity and a 55-minute designation; 99242 has straightforward decision-making and a 20-minute designation.
- 99252Hospital consultationStraightforward level
- 99252 is an inpatient or observation consultation code. 99242 is for an office or outpatient consultation.
- 99213Office visitEstablished patient, low complexity
- 99213 describes an established-patient office or outpatient E/M visit, while 99242 describes an outpatient consultation.
99242 billing questions
Does Medicare accept 99242?
No. Medicare status I means 99242 is not valid for Medicare; Medicare uses a different code to report and pay for the service.
How does 99242 differ from 99243?
Both are office or outpatient consultations. 99242 is the straightforward-level service with a 20-minute time designation; 99243 is the next level, with low decision-making complexity and a 30-minute designation.
Does the 20-minute designation make 99242 valid for Medicare?
No. The time designation describes the consultation service level, but Medicare does not accept 99242.
How does 99242 differ from 99252?
99242 is for an office or outpatient consultation; 99252 is for an inpatient or observation consultation.
Can 99242 be used for a new or an established patient?
Yes. The code family includes both new and established patients.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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