CPT code 99253: Inpatient consultation, low MDM, 45 minutes2026 Medicare rate & RVUs in Maryland
A specialist’s requested inpatient or observation evaluation with low medical decision making, reported by payers that recognize consultation codes.
CMS doesn’t publish an office rate for 99253 in Maryland.
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 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 in Maryland
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Baltimore area, MD | Unavailable | Unavailable |
| Rest of Maryland | Unavailable | Unavailable |
| Washington, DC area | Unavailable | Unavailable |
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
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
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.
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
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