CPT code 99446: Consultation, 5–10 minutes2026 Medicare rate & RVUs in North Carolina

A consultant physician reviews a case and advises the treating clinician through a brief remote discussion and written report lasting 5–10 minutes.

CMS RVU26DEffective Oct 1, 2026One payment locality6.3K Medicare services in 2024

In North Carolina, Medicare pays $18.15 for 99446 in the office and $15.35 when it’s performed in a hospital or facility.

$18.15Office (non-facility)
$15.35Hospital or facility
−4.7%vs the national office rate ($19.04)

Check a contract rate as a % of Medicare · 99446 nationwide

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

We’ll open 99446 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in North Carolina
  2. What 99446 covers
  3. Compared with other areas
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Related codes
  8. Rate history
  9. Where it applies
  10. Billing questions
  11. Sources

What 99446 covers

99446 is for a consultant physician’s brief remote review and discussion of a patient’s case with the treating or requesting clinician, followed by a written report. It is useful when a clinician needs specialty input on diagnosis or management without arranging a face-to-face visit with the consultant. For example, a primary care clinician may request a cardiologist’s advice about medication management in a patient with a complex cardiac history. The patient is not the other party to the clinician-to-clinician discussion.

Select this tier using the consultant’s time spent on the medical discussion and record review: 5–10 minutes supports 99446. Document the request and clinical question, relevant records reviewed, communication with the treating clinician, time, and written recommendations. The discussion, review, and report form parts of this consultative service. CMS assigns physician work and practice-expense values to the code in the physician fee schedule; the consultant reports the service, not the treating clinician’s referral-coordination work.

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.

How North Carolina compares for 99446

Across 109 of 109 payment localities, the office rate for 99446 runs from $17.54 in Arkansas to $24.67 in Alaska. North Carolina pays $18.15. The RVUs are the same everywhere; the geographic indexes change the dollars.

99446 in North Carolina vs other payment areas
  1. North Carolina · this page$18.15
  2. Los Angeles, CA · California$20.17+$2.02
  3. Washington, DC area · District of Columbia$20.89+$2.74
  4. Miami, FL · Florida$21.33+$3.18
  5. Chicago, IL · Illinois$20.88+$2.73
  6. Manhattan, NY · New York$21.54+$3.39
  7. Alaska · Alaska$24.67+$6.52

Other areas in North Carolina first, then benchmark localities. Bars start at $0.

Every other payment area

99446 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$17.71$15.08
ArkansasArkansas$17.54$14.96
ArizonaArizona$18.66$15.75
Bakersfield, CACalifornia$19.32$16.02
Chico, CACalifornia$19.19$15.90
El Centro, CACalifornia$19.20$15.91
Fresno, CACalifornia$19.19$15.90
Hanford, CACalifornia$19.19$15.90

99446 rates by state

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

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.

$17.54

$24.67

Color shows the midpoint of each state’s locality range.

View every state and territory as a table
99446 office rate range by state
State / territoryOffice rate rangeLocalities
AK$24.671
AL$17.711
AR$17.541
AZ$18.661
CA$19.19–$22.3629
CO$19.271
CT$20.021
DC$20.891
DE$18.891
FL$19.45–$21.333
GA$18.65–$19.442
GU$19.301
HI$19.301
IA$17.721
ID$17.851
IL$19.27–$20.884
IN$17.911
KS$17.801
KY$18.261
LA$18.29–$18.872
MA$19.27–$20.542
MD$19.12–$20.893
ME$18.05–$18.492
MI$18.69–$19.742
MN$18.271
MO$18.17–$18.753
MS$17.851
MT$19.041
NC$18.151
ND$18.241
NE$17.741
NH$19.121
NJ$20.19–$20.832
NM$18.811
NV$18.821
NY$18.34–$22.075
OH$18.531
OK$18.101
OR$18.62–$19.552
PA$18.47–$19.752
PR$19.081
RI$19.311
SC$18.381
SD$18.151
TN$17.871
TX$18.40–$19.598
UT$18.541
VA$18.54–$20.892
VI$19.081
VT$18.321
WA$19.19–$20.742
WI$17.861
WV$18.831
WY$18.691

See 99446 in every payment locality

How the 99446 rate is calculated

Each of 99446’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 · 99446

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.35

0.35 RVUs× 1.000 GPCI

Practice expense0.18

0.18 RVUs× 1.000 GPCI

Malpractice0.04

0.04 RVUs× 1.000 GPCI

Adjusted RVUs

0.5700

Conversion factor

$33.4009

Medicare rate

$19.04

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

The exact North Carolina inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,113

Code
99446
Physician work
0.35
Practice expense
0.18
Malpractice
0.04

GPCI2026.csv

83

Locality
North Carolina
Physician work
1.000
Practice expense
0.933
Malpractice
0.639
Office calculation for 99446 in North Carolina
ComponentRVULocality factorAdjusted
Physician work0.35× 1.0000.3500
Practice expense0.18× 0.9330.1679
Malpractice0.04× 0.6390.0256
Total RVUs0.5435
Conversion factor× 33.4009

Office rate, North Carolina$18.15

Office: (0.35 × 1 + 0.18 × 0.933 + 0.04 × 0.639) × $33.4009 = $18.15

Facility: (0.35 × 1 + 0.09 × 0.933 + 0.04 × 0.639) × $33.4009 = $15.35

Open 99446 in the RVU calculator

Payment rules and modifiers for 99446

99446 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 · 99446

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

$19.04

Non-facility (office)
$19.04
Facility
$16.03

Higher because the practice carries its own overhead.

How 99446 has changed in North Carolina

99446 · Office / nonfacility

$18.15

Effective 2026-10-01

The base rate is $1.69 higher than on 2025-10-01, moving from $16.46 to $18.15 (10.3%).

It is unchanged from the immediately preceding available release, effective 2026-07-01.

Base rate by release · bars start at $0 · select a bar to compare

One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.

What changed, release by release
  1. January 1, 2026

    RVU26A

    $16.46changed to$18.15

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.15 changed to 0.18
    • Malpractice RVU 0.03 changed to 0.04
    • Practice expense GPCI 0.926 changed to 0.933
    • Malpractice GPCI 0.665 changed to 0.639

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $16.94changed to$16.46

    • Conversion factor 33.2875 changed to 32.3465

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $16.66changed to$16.94

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $17.26changed to$16.66

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.14 changed to 0.15
    • Malpractice RVU 0.04 changed to 0.03
    • Practice expense GPCI 0.927 changed to 0.926
    • Malpractice GPCI 0.742 changed to 0.665
  5. January 1, 2023

    RVU23A

    $18.06changed to$17.26

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.15 changed to 0.14
    • Practice expense GPCI 0.928 changed to 0.927
    • Malpractice GPCI 0.819 changed to 0.742

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $18.21changed to$18.06

    • Conversion factor 34.8931 changed to 34.6062

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $17.81changed to$18.21

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense RVU 0.13 changed to 0.15
    • Malpractice RVU 0.03 changed to 0.04
    • Practice expense GPCI 0.930 changed to 0.928
    • Malpractice GPCI 0.757 changed to 0.819

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $17.81changed to$17.81

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense RVU 0.14 changed to 0.13
    • Malpractice RVU 0.02 changed to 0.03
    • Practice expense GPCI 0.931 changed to 0.930
    • Malpractice GPCI 0.695 changed to 0.757

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    No ratechanged to$17.81

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2014

    RVU14A

    No ratechanged toNo rate

    Held through RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D.

  11. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$18.15$15.35RVU26D
2026-07-01$18.15$15.35RVU26C
2026-04-01$18.15$15.35RVU26B
2026-01-01$18.15$15.35RVU26A
2025-10-01$16.46$16.46RVU25D
2025-07-01$16.46$16.46RVU25C
2025-04-01$16.46$16.46RVU25B
2025-01-01$16.46$16.46RVU25A
2024-10-01$16.94$16.94RVU24D
2024-07-01$16.94$16.94RVU24C
2024-04-01$16.94$16.94RVU24B
2024-03-09$16.94$16.94RVU24AR
2024-01-01$16.66$16.66RVU24A
2023-10-01$17.26$17.26RVU23D
2023-07-01$17.26$17.26RVU23C
2023-04-01$17.26$17.26RVU23B
2023-01-01$17.26$17.26RVU23A
2022-10-01$18.06$18.06RVU22D
2022-07-01$18.06$18.06RVU22C
2022-04-01$18.06$18.06RVU22B
2022-01-01$18.06$18.06RVU22A
2021-10-01$18.21$18.21RVU21D
2021-07-01$18.21$18.21RVU21C
2021-04-01$18.21$18.21RVU21B
2021-01-01$18.21$18.21RVU21A
2020-10-01$17.81$17.81RVU20D
2020-07-01$17.81$17.81RVU20C
2020-04-01$17.81$17.81RVU20B
2020-01-01$17.81$17.81RVU20A
2019-10-01$17.81$17.81RVU19D
2019-07-01$17.81$17.81RVU19C
2019-04-01$17.81$17.81RVU19B
2019-01-01$17.81$17.81RVU19A
2018-10-01Separate payment rules applySeparate payment rules applyRVU18D
2018-07-01Separate payment rules applySeparate payment rules applyRVU18C
2018-04-01Separate payment rules applySeparate payment rules applyRVU18B
2018-01-01Separate payment rules applySeparate payment rules applyRVU18AR1
2017-10-01Separate payment rules applySeparate payment rules applyRVU17D
2017-07-01Separate payment rules applySeparate payment rules applyRVU17C
2017-04-01Separate payment rules applySeparate payment rules applyRVU17B
2017-01-01Separate payment rules applySeparate payment rules applyRVU17A
2016-10-01Separate payment rules applySeparate payment rules applyRVU16D
2016-07-01Separate payment rules applySeparate payment rules applyRVU16C
2016-04-01Separate payment rules applySeparate payment rules applyRVU16B
2016-01-01Separate payment rules applySeparate payment rules applyRVU16A
2015-10-01Separate payment rules applySeparate payment rules applyRVU15D
2015-07-01Separate payment rules applySeparate payment rules applyRVU15C
2015-04-01Separate payment rules applySeparate payment rules applyRVU15B
2015-01-01Separate payment rules applySeparate payment rules applyRVU15A
2014-10-01Separate payment rules applySeparate payment rules applyRVU14D
2014-07-01Separate payment rules applySeparate payment rules applyRVU14C
2014-04-01Separate payment rules applySeparate payment rules applyRVU14B
2014-01-01Separate payment rules applySeparate payment rules applyRVU14A
2013-10-01Not in this releaseNot in this releaseRVU13D
2013-07-01Not in this releaseNot in this releaseRVU13C
2013-04-01Not in this releaseNot in this releaseRVU13B
2013-01-01Not in this releaseNot in this releaseRVU13AR

Price 99446 for an earlier date of service

Where the North Carolina rate applies

North Carolina is a Medicare payment area, not a city. Our Census mapping connects it to 785 cities and communities in North Carolina. Some span more than one payment area; confirm with the service ZIP.

  • Aberdeen
  • Advance
  • Ahoskie
  • Alamance
  • Albemarle
  • Alexis
  • Alliance
  • Altamahaw

Browse all communities in North Carolina

99446 billing questions

When should 99446 be chosen instead of 99447?

Use 99446 when the consultant’s medical discussion and record-review time totals 5–10 minutes. The next time tier, 99447, is for 11–20 minutes.

Does 99446 include a written report?

Yes. The consultant’s written recommendations to the treating or requesting clinician are part of the service, along with the case review and clinician-to-clinician discussion.

Can time spent speaking with the patient count toward 99446?

No. The time tier is based on the consultant’s medical discussion with the treating or requesting clinician and review of the case records.

How does 99446 differ from 99451?

99446 represents the short time tier for a consult that includes verbal clinician-to-clinician discussion and a written report. 99451 is used for a remote consult with a written report but no verbal discussion.

Who reports 99446: the consultant or the clinician requesting advice?

The consultant physician reports 99446 for the review, discussion, and recommendations. The requesting clinician’s referral-coordination work is represented separately by 99452 when its requirements are met.

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

Show the CMS file lines behind this rate
RVUs for 99446PPRRVU2026_Oct_nonQPP.csv, line 13,113 (RVU26D)
Geographic factors for North CarolinaGPCI2026.csv, line 83 (RVU26D)

Open CMS sourceHow we calculate rates

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