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

CMS doesn’t publish an office rate for 99254 in California.

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

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 in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

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.

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.

99254 compared with similar codes

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.

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