CPT code 99255: Inpatient consultation, high level2026 Medicare rate & RVUs

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

What 99255 covers

99255 represents a high-level consultation for a new or established patient receiving inpatient or observation care. Another clinician requests an opinion or recommendations about the patient’s condition or management. The consultant evaluates the patient and communicates findings and recommendations to the requesting clinician. Its consultative purpose distinguishes it from routine ongoing hospital care.

Medicare assigns 99255 status I: the code is not valid for Medicare, and Medicare uses a different code to report and pay for the service. For Medicare claims, report the hospital evaluation and management service that matches the encounter instead. Depending on the service performed, an initial hospital care code such as 99221–99223 or a subsequent hospital care code such as 99231–99233 may be appropriate. The high consultation level does not make 99255 valid for Medicare.

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 99255 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

99255 rates by state

Office rate range in each state. Select a state to see its payment localities.

How the 99255 rate is calculated

Each of 99255’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 99255

99255 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.

99255 compared with similar codes

How to choose

99254Hospital consultationModerate, 60-minute level

Choose 99254 for a moderate-level inpatient or observation consultation; 99255 represents the high level.

99223Initial hospital visitHigh decision making or 75 minutes

99223 reports high-level initial hospital care, not a consultation. For Medicare, use an appropriate hospital E/M code based on the service performed rather than 99255.

99245Office consultationHigh level, 55 minutes

99245 is the high-level consultation code for an office or other outpatient setting; 99255 is for inpatient or observation care.

99233Hospital follow-up visitSubsequent day, high complexity

99233 reports subsequent hospital care. 99255 describes a consultation and is not valid for Medicare.

Codes related to 99255

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