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CPT code 99252: Hospital consultation, straightforward level2026 Medicare rate & RVUs

An inpatient or observation consultation for a new or established patient at the straightforward level, associated with a 35-minute service.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99252

Hospital consultation, straightforward level

Office or facility?

Work RVUs
1.5
Total RVUs
2.10
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99252 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99252 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99252 covers

99252 identifies an inpatient or observation consultation for a new or established patient at the straightforward level, with 35 minutes associated with the service. It belongs to the inpatient and observation consultation series, distinct from initial or subsequent hospital or observation care and from office or outpatient consultations. It is not a code for routine subsequent care.

Medicare classifies 99252 as not valid for Medicare (status I); Medicare uses a different code to report and pay for this service. The 35-minute figure is associated time, not 35 billing units. Codes 99253, 99254, and 99255 are higher levels in the same inpatient and observation consultation series.

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 99252 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

99252 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

99252 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99252 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99252 rate is calculated

Each of 99252’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 · 99252

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.50

1.50 RVUs× 1.000 GPCI

Practice expense0.52

0.52 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

2.1000

Conversion factor

$33.4009

Medicare rate

$70.14

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99252

99252 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 · 99252

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

99252 isn’t priced in this setting.

99252 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99252

    Hospital consultation, straightforward level1.5 wRVU

    Not priced

  • 99253

    Inpatient consultation, low MDM, 45 minutes2 wRVU

    Not priced

  • 99221

    Initial hospital care, straightforward or low MDM, 40 minutes1.63 wRVU

    Not priced

  • 99242

    Office consultation, straightforward level1.08 wRVU

    Not priced

How to choose

99253Inpatient consultationLow MDM, 45 minutes
Both are inpatient or observation consultation codes; 99252 is the straightforward level, while 99253 is the next level in the series.
99221Initial hospital careStraightforward or low MDM, 40 minutes
99221 is in the initial hospital or observation care series, while 99252 is in the consultation series.
99242Office consultationStraightforward level
99242 is an office or outpatient consultation code; 99252 is for an inpatient or observation consultation.

Codes related to 99252

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

Codes related to 99252
CodeHow it relatesNational office range
Same family
99253Inpatient consultation, low MDM, 45 minutesNext level in the inpatient and observation consultation series.No office rate
99254Hospital consultation, moderate, 60-minute levelHigher level in the inpatient and observation consultation series.No office rate
99255Inpatient consultation, high levelHighest level in the inpatient and observation consultation series.No office rate

99252 billing questions

Can 99252 be reported to Medicare?

No. Medicare classifies 99252 as not valid for Medicare (status I) and uses a different code to report and pay for this service.

How does 99252 differ from 99253?

Both are inpatient or observation consultation codes. 99252 is the straightforward level; 99253 is the next level in the series.

Does 99252 represent 35 units or 35 minutes?

The code is associated with a 35-minute service; it does not represent 35 billing units.

How does 99252 differ from initial hospital or observation care?

99252 is in the inpatient and observation consultation series. Code 99221 is in the initial hospital or observation care series.

How does 99252 differ from 99242?

99252 is for an inpatient or observation consultation; 99242 is for an office or outpatient consultation.

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

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