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CPT code 99253: Inpatient consultation, low MDM, 45 minutes2026 Medicare rate & RVUs

A specialist’s requested inpatient or observation evaluation with low medical decision making, reported by payers that recognize consultation codes.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99253

Inpatient consultation, low MDM, 45 minutes

Office or facility?

Work RVUs
2
Total RVUs
2.96
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99253 →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 99253 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 99253 covers

Code 99253 represents a specialist’s evaluation requested by another physician or qualified health care professional to address a clinical question during a hospital inpatient or observation stay. The consultant assesses the patient and relevant records, develops an opinion or recommendations, and communicates findings to the requesting clinician. It may apply to a new or established patient; ongoing subsequent hospital management is a different service.

For Medicare, status I means 99253 is not valid for reporting and payment. Medicare uses initial inpatient or observation E/M codes 99221, 99222, or 99223 instead, as appropriate. For payers that recognize inpatient consultation codes, 99253 corresponds to low medical decision making or a 45-minute time level. It is reported as one service, not as a per-unit 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 99253 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

99253 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

99253 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
99253 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 99253 rate is calculated

Each of 99253’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 · 99253

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.00

2.00 RVUs× 1.000 GPCI

Practice expense0.84

0.84 RVUs× 1.000 GPCI

Malpractice0.12

0.12 RVUs× 1.000 GPCI

Adjusted RVUs

2.9600

Conversion factor

$33.4009

Medicare rate

$98.87

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

Payment rules and modifiers for 99253

99253 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 · 99253

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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99253 isn’t priced in this setting.

99253 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99253

    Inpatient consultation, low MDM, 45 minutes2 wRVU

    Not priced

  • 99221

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

    Not priced

  • 99231

    Subsequent hospital visit, straightforward or low MDM, 25 minutes1 wRVU

    Not priced

  • 99252

    Hospital consultation, straightforward level1.5 wRVU

    Not priced

  • 99254

    Hospital consultation, moderate, 60-minute level2.72 wRVU

    Not priced

How to choose

99221Initial hospital careStraightforward or low MDM, 40 minutes
Medicare uses 99221–99223 rather than inpatient consultation codes. 99221 is an initial inpatient or observation E/M service, not a consultation code.
99231Subsequent hospital visitStraightforward or low MDM, 25 minutes
99231 is for subsequent inpatient or observation care; 99253 describes a requested consultation, not a routine follow-up visit.
99252Hospital consultationStraightforward level
99252 is the lower consultation level, corresponding to straightforward medical decision making or a 35-minute time level; 99253 corresponds to low MDM or 45 minutes.
99254Hospital consultationModerate, 60-minute level
99254 is the next consultation level, for moderate medical decision making or a 60-minute time level; 99253 is the low-MDM, 45-minute level.

Codes related to 99253

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

Codes related to 99253
CodeHow it relatesNational office range
Used instead
99221Initial hospital care, straightforward or low MDM, 40 minutesMedicare initial inpatient or observation E/M alternative at the lowest listed level.No office rate
99222Initial hospital visit, moderate MDM or 55 minutesMedicare initial inpatient or observation E/M alternative at the moderate level.No office rate
99223Initial hospital visit, high decision making or 75 minutesMedicare initial inpatient or observation E/M alternative at the highest level.No office rate
Same family
99252Hospital consultation, straightforward levelLower-level inpatient or observation consultation code.No office rate
99254Hospital consultation, moderate, 60-minute levelHigher-level inpatient or observation consultation code.No office rate
99255Inpatient consultation, high levelHighest-level inpatient or observation consultation code.No office rate

99253 billing questions

Can 99253 be reported to Medicare?

No. Medicare status I means 99253 is not valid for Medicare reporting; use the appropriate initial inpatient or observation E/M code, 99221–99223.

Who reports 99253?

A consulting physician or qualified health care professional reports it for a requested evaluation in an inpatient or observation setting, with findings communicated to the requesting clinician.

How does 99253 differ from 99252?

Both are inpatient or observation consultation codes. 99252 represents straightforward medical decision making or a 35-minute time level; 99253 represents low medical decision making or a 45-minute time level.

When would 99254 be more appropriate?

For payers recognizing consultation codes, 99254 is the next level, for moderate medical decision making or a 60-minute time level. 99253 is the low-level, 45-minute code.

Does a modifier make 99253 payable to Medicare?

No. A modifier does not change its Medicare status I; report the appropriate Medicare initial inpatient or observation code instead.

Is 99253 billed in multiple units?

No. It represents one consultation service; the 45-minute level is a time-based selection, not a unit quantity.

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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