CPT code 99245: Office consultation, high level, 55 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 99245 covers

99245 represents a high-level consultation in an office or other outpatient setting for a new or established patient. A physician or qualified health care professional provides an opinion or advice in response to a request from another clinician or appropriate source and communicates findings and recommendations to the requester. The service is selected at this level based on medical decision making or, when time is used for code selection, 55 minutes of qualifying time.

Medicare classifies 99245 as not valid for Medicare, status I, and uses a different code to report and pay for the service. For a Medicare office or outpatient E/M service, the appropriate code is selected from 99202–99205 for a new patient or 99211–99215 for an established patient, based on the documented service. The consultation request and communication of findings should be documented; 99245 itself is not the Medicare billing code.

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 99245 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

99245 rates by state

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

How the 99245 rate is calculated

Each of 99245’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 99245

99245 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.

99245 compared with similar codes

How to choose

99244Office consultationModerate level

99244 is the moderate-level office or outpatient consultation; 99245 is the high-level consultation.

99255Inpatient consultationHigh level

99255 is for a high-level consultation in an inpatient or observation setting; 99245 is for an office or outpatient setting.

99205Office visitNew patient, high complexity

99205 is an office or outpatient E/M code for a new patient and is used instead of a consultation code for a comparable Medicare service.

99215Office visitEstablished patient, high complexity

99215 is an office or outpatient E/M code for an established patient and is used instead of a consultation code for a comparable Medicare service.

Codes related to 99245

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