CPT code 99243: Office consultation, low MDM, 30 minutes2026 Medicare rate & RVUs

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

What 99243 covers

This code is for an office or other outpatient consultation requested by another physician or qualified health care professional for an opinion or advice about a patient’s condition. The consulting clinician evaluates the question, develops recommendations, and communicates findings to the requesting professional. The patient can be new or established with the consultant; the request for consultation distinguishes the service from a visit initiated solely for the consultant’s ongoing care. Specialists commonly report it for consultations in offices and outpatient clinics.

The code represents low medical decision making or 30 minutes of total service time. Medicare classifies 99243 as status I, meaning it is not valid for Medicare payment; Medicare uses a different code to report and pay for the service. Report one consultation service rather than multiple units based on the 30-minute time level.

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 99243 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99243 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99243 rate is calculated

Each of 99243’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.

Payment rules and modifiers for 99243

99243 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.

99243 compared with similar codes

How to choose

99242Office consultationStraightforward level

Both describe office or outpatient consultations. 99242 is the lower level; 99243 represents low medical decision making or 30 minutes of total time.

99244Office consultationModerate level

Both describe office or outpatient consultations, but 99244 represents a higher level than 99243.

99214Office visitEstablished patient, moderate complexity

99214 is an established-patient office or outpatient E/M code, not a consultation code. 99243 describes an office or outpatient consultation for a new or established patient.

Codes related to 99243

Related codes aren’t interchangeable: bill the code that matches the service performed.

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

Open CMS sourceHow we calculate rates