CPT code 99243: Office consultation, low MDM, 30 minutes2026 Medicare rate & RVUs in Florida
An office or outpatient consultation for a requested specialist opinion, reported for low medical decision making or 30 minutes of total service time.
CMS doesn’t publish an office rate for 99243 in Florida.
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 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 in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale, FL | Unavailable | Unavailable |
| Miami, FL | Unavailable | Unavailable |
| Rest of Florida | Unavailable | Unavailable |
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.
How the rate is built · 99243
RVUs × geographic indexes × conversion factor
Work1.80
1.80 RVUs× 1.000 GPCI
Practice expense1.46
1.46 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
3.3700
Conversion factor
$33.4009
Medicare rate
$112.56
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99243
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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99243 isn’t priced in this setting.
99243 compared with similar codes
Compare codes · National
4 codes, side by side
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.
99243 billing questions
Does Medicare pay 99243?
No. Medicare status I means 99243 is not valid for Medicare payment; Medicare uses a different code to report and pay for the service.
What distinguishes 99243 from 99242 or 99244?
These are office or outpatient consultation levels. 99243 represents low medical decision making or 30 minutes of total time; 99242 is a lower level, while 99244 is a higher level.
Does the patient have to be new to the consultant?
No. This consultation code applies to new or established patients. The service involves a request for an opinion or advice and communication of the consultant’s findings.
How many units should be reported?
Report one consultation service. The 30-minute time level is not reported as multiple units.
What should Medicare bill instead?
Medicare reports and pays for the service under a different code; 99243 itself is not valid for Medicare.
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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