CPT code 99252: Hospital consultation, straightforward level2026 Medicare rate & RVUs in Missouri
An inpatient or observation consultation for a new or established patient at the straightforward level, associated with a 35-minute service.
CMS doesn’t publish an office rate for 99252 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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On this page 9 sections
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 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 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
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
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99252 isn’t priced in this setting.
99252 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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