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CPT code 99254: Hospital consultation, moderate, 60-minute level2026 Medicare rate & RVUs

This inpatient or observation consultation represents a moderate-level requested specialist evaluation, reported when the service meets the applicable medical decision-making or time criterion.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99254

Hospital consultation, moderate, 60-minute level

Office or facility?

Work RVUs
2.72
Total RVUs
4.12
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99254 →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 99254 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 99254 covers

An inpatient or observation consultation is a requested assessment of a clinical question, with findings and recommendations communicated to the requesting clinician. A specialist may see a patient who is new to or already known by that consultant. The service occurs during an inpatient stay or observation encounter and is distinct from office or other outpatient consultation codes. Select the moderate consultation level when the service meets the applicable medical decision-making or time criterion.

For Medicare, 99254 has status I and is not valid for Medicare reporting; Medicare uses a different code to report and pay for the service. This code represents a moderate-level inpatient or observation consultation and corresponds to 60 minutes when time is the basis for selection.

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 99254 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

99254 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

99254 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
99254 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 99254 rate is calculated

Each of 99254’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 · 99254

RVUs × geographic indexes × conversion factor

Office or facility?

Work2.72

2.72 RVUs× 1.000 GPCI

Practice expense1.23

1.23 RVUs× 1.000 GPCI

Malpractice0.17

0.17 RVUs× 1.000 GPCI

Adjusted RVUs

4.1200

Conversion factor

$33.4009

Medicare rate

$137.61

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

Payment rules and modifiers for 99254

99254 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 · 99254

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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99254 isn’t priced in this setting.

99254 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99254

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

    Not priced

  • 99253

    Inpatient consultation, low MDM, 45 minutes2 wRVU

    Not priced

  • 99255

    Inpatient consultation, high level3.86 wRVU

    Not priced

  • 99222

    Initial hospital visit, moderate MDM or 55 minutes2.6 wRVU

    Not priced

  • 99244

    Office consultation, moderate level2.69 wRVU

    Not priced

How to choose

99253Inpatient consultationLow MDM, 45 minutes
Both are inpatient or observation consultation levels. 99253 is the lower level; 99254 is the moderate level.
99255Inpatient consultationHigh level
99255 is the higher inpatient or observation consultation level. 99254 represents the moderate level.
99222Initial hospital visitModerate MDM or 55 minutes
99222 describes initial hospital or observation care, while 99254 is an inpatient or observation consultation code.
99244Office consultationModerate level
99244 is a moderate-level consultation code for an office or other outpatient setting; 99254 is for an inpatient or observation consultation.

Codes related to 99254

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

Codes related to 99254
CodeHow it relatesNational office range
Same family
99252Hospital consultation, straightforward levelLower inpatient or observation consultation level.No office rate
99253Inpatient consultation, low MDM, 45 minutesLower inpatient or observation consultation level.No office rate
99255Inpatient consultation, high levelHigher inpatient or observation consultation level.No office rate
Used instead
99244Office consultation, moderate levelModerate-level consultation for an office or other outpatient setting.No office rate

99254 billing questions

What distinguishes 99254 from 99253 or 99255?

These are inpatient or observation consultation levels. 99253 is the lower level, 99254 the moderate level, and 99255 the higher level.

When is 99244 a better fit?

99244 is a moderate-level consultation for an office or other outpatient setting. 99254 is for an inpatient or observation consultation.

Does the patient have to be new to the consultant?

No. The consultation level can apply to a new or established patient when the service meets the consultation requirements.

How does the 60-minute time relate to 99254?

The code represents the moderate consultation level when selected by medical decision making, or the 60-minute level when selected by time.

How does Medicare treat 99254?

Medicare status I means 99254 is not valid for Medicare reporting. Medicare uses a different code to report and pay for the service.

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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