CPT code 99446: Consultation, 5–10 minutes2026 Medicare rate & RVUs in Vermont
A consultant physician reviews a case and advises the treating clinician through a brief remote discussion and written report lasting 5–10 minutes.
In Vermont, Medicare pays $18.32 for 99446 in the office and $15.34 when it’s performed in a hospital or facility.
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.
On this page 11 sections
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 Vermont 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. Vermont pays $18.32. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Vermont · this page$18.32
- Los Angeles, CA · California$20.17+$1.85
- Washington, DC area · District of Columbia$20.89+$2.57
- Miami, FL · Florida$21.33+$3.01
- Chicago, IL · Illinois$20.88+$2.56
- Manhattan, NY · New York$21.54+$3.22
- Alaska · Alaska$24.67+$6.35
Other areas in Vermont first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| 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 |
| Madera, CACalifornia | $19.19 | $15.90 |
| Merced, CACalifornia | $19.19 | $15.90 |
| Modesto, CACalifornia | $19.19 | $15.90 |
| Napa, CACalifornia | $21.03 | $17.07 |
| Oxnard, CACalifornia | $19.96 | $16.40 |
| Redding, CACalifornia | $19.19 | $15.90 |
| Rest of CaliforniaCalifornia | $19.19 | $15.90 |
| Riverside, CACalifornia | $19.63 | $16.34 |
| Sacramento, CACalifornia | $19.82 | $16.32 |
| Salinas, CACalifornia | $19.74 | $16.25 |
| San Diego, CACalifornia | $19.96 | $16.36 |
| Marin County, CACalifornia | $21.89 | $17.65 |
| San Francisco, CACalifornia | $21.85 | $17.61 |
| San Benito County, CACalifornia | $22.36 | $18.03 |
| Santa Clara County, CACalifornia | $22.18 | $17.84 |
| San Luis Obispo, CACalifornia | $19.45 | $16.03 |
| Santa Cruz, CACalifornia | $19.96 | $16.30 |
| Santa Maria, CACalifornia | $19.74 | $16.24 |
| Santa Rosa, CACalifornia | $20.14 | $16.45 |
| Stockton, CACalifornia | $19.19 | $15.90 |
| Vallejo, CACalifornia | $20.96 | $17.00 |
| Visalia, CACalifornia | $19.19 | $15.90 |
| Yuba City, CACalifornia | $19.19 | $15.90 |
| ColoradoColorado | $19.27 | $16.07 |
| ConnecticutConnecticut | $20.02 | $16.78 |
| DelawareDelaware | $18.89 | $15.92 |
| Fort Lauderdale, FLFlorida | $20.20 | $17.15 |
| Rest of FloridaFlorida | $19.45 | $16.57 |
| Atlanta, GAGeorgia | $19.44 | $16.38 |
| Rest of GeorgiaGeorgia | $18.65 | $15.96 |
| Hawaii, Guam, HIHawaii | $19.30 | $15.88 |
| IowaIowa | $17.72 | $14.97 |
| IdahoIdaho | $17.85 | $15.09 |
| East St. Louis, ILIllinois | $19.91 | $17.15 |
| Rest of IllinoisIllinois | $19.27 | $16.52 |
| Suburban Chicago, ILIllinois | $20.31 | $17.23 |
| IndianaIndiana | $17.91 | $15.13 |
| KansasKansas | $17.80 | $15.08 |
| KentuckyKentucky | $18.26 | $15.59 |
| New Orleans, LALouisiana | $18.87 | $16.04 |
| Rest of LouisianaLouisiana | $18.29 | $15.63 |
| Metropolitan Boston, MAMassachusetts | $20.54 | $16.95 |
| Rest of MassachusettsMassachusetts | $19.27 | $16.11 |
| Baltimore area, MDMaryland | $19.98 | $16.76 |
| Rest of MarylandMaryland | $19.12 | $16.08 |
| Rest of MaineMaine | $18.05 | $15.29 |
| Southern Maine, MEMaine | $18.49 | $15.51 |
| Detroit, MIMichigan | $19.74 | $16.84 |
| Rest of MichiganMichigan | $18.69 | $15.94 |
| MinnesotaMinnesota | $18.27 | $15.18 |
| Metropolitan Kansas City, MOMissouri | $18.64 | $15.82 |
| Metropolitan St. Louis, MOMissouri | $18.75 | $15.89 |
| Rest of MissouriMissouri | $18.17 | $15.58 |
| MississippiMississippi | $17.85 | $15.27 |
| MontanaMontana | $19.04 | $16.03 |
| North CarolinaNorth Carolina | $18.15 | $15.35 |
| North DakotaNorth Dakota | $18.24 | $15.24 |
| NebraskaNebraska | $17.74 | $14.97 |
| New HampshireNew Hampshire | $19.12 | $15.99 |
| Northern New JerseyNew Jersey | $20.83 | $17.34 |
| Rest of New JerseyNew Jersey | $20.19 | $16.91 |
| New MexicoNew Mexico | $18.81 | $16.05 |
| NevadaNevada | $18.82 | $15.81 |
| NYC suburbs and Long Island, NYNew York | $22.07 | $18.49 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $20.42 | $17.12 |
| Queens, NYNew York | $21.47 | $17.92 |
| Rest of New YorkNew York | $18.34 | $15.49 |
| OhioOhio | $18.53 | $15.78 |
| OklahomaOklahoma | $18.10 | $15.41 |
| Portland, OROregon | $19.55 | $16.21 |
| Rest of OregonOregon | $18.62 | $15.62 |
| Metropolitan Philadelphia, PAPennsylvania | $19.75 | $16.62 |
| Rest of PennsylvaniaPennsylvania | $18.47 | $15.71 |
| Puerto RicoPuerto Rico | $19.08 | $16.05 |
| Rhode IslandRhode Island | $19.31 | $16.21 |
| South CarolinaSouth Carolina | $18.38 | $15.60 |
| South DakotaSouth Dakota | $18.15 | $15.15 |
| TennesseeTennessee | $17.87 | $15.14 |
| Austin, TXTexas | $19.26 | $16.08 |
| Beaumont, TXTexas | $18.40 | $15.67 |
| Brazoria, TXTexas | $18.78 | $15.80 |
| Dallas, TXTexas | $18.93 | $15.94 |
| Fort Worth, TXTexas | $18.89 | $15.92 |
| Galveston, TXTexas | $18.86 | $15.88 |
| Houston, TXTexas | $19.59 | $16.61 |
| Rest of TexasTexas | $18.60 | $15.75 |
| UtahUtah | $18.54 | $15.72 |
| VirginiaVirginia | $18.54 | $15.59 |
| Virgin Islands, VIUnited States Virgin Islands | $19.08 | $16.05 |
| Rest of WashingtonWashington | $19.19 | $16.02 |
| King County, WAWashington | $20.74 | $17.05 |
| WisconsinWisconsin | $17.86 | $14.98 |
| West VirginiaWest Virginia | $18.83 | $16.21 |
| WyomingWyoming | $18.69 | $15.69 |
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
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $24.67 | 1 |
| AL | $17.71 | 1 |
| AR | $17.54 | 1 |
| AZ | $18.66 | 1 |
| CA | $19.19–$22.36 | 29 |
| CO | $19.27 | 1 |
| CT | $20.02 | 1 |
| DC | $20.89 | 1 |
| DE | $18.89 | 1 |
| FL | $19.45–$21.33 | 3 |
| GA | $18.65–$19.44 | 2 |
| GU | $19.30 | 1 |
| HI | $19.30 | 1 |
| IA | $17.72 | 1 |
| ID | $17.85 | 1 |
| IL | $19.27–$20.88 | 4 |
| IN | $17.91 | 1 |
| KS | $17.80 | 1 |
| KY | $18.26 | 1 |
| LA | $18.29–$18.87 | 2 |
| MA | $19.27–$20.54 | 2 |
| MD | $19.12–$20.89 | 3 |
| ME | $18.05–$18.49 | 2 |
| MI | $18.69–$19.74 | 2 |
| MN | $18.27 | 1 |
| MO | $18.17–$18.75 | 3 |
| MS | $17.85 | 1 |
| MT | $19.04 | 1 |
| NC | $18.15 | 1 |
| ND | $18.24 | 1 |
| NE | $17.74 | 1 |
| NH | $19.12 | 1 |
| NJ | $20.19–$20.83 | 2 |
| NM | $18.81 | 1 |
| NV | $18.82 | 1 |
| NY | $18.34–$22.07 | 5 |
| OH | $18.53 | 1 |
| OK | $18.10 | 1 |
| OR | $18.62–$19.55 | 2 |
| PA | $18.47–$19.75 | 2 |
| PR | $19.08 | 1 |
| RI | $19.31 | 1 |
| SC | $18.38 | 1 |
| SD | $18.15 | 1 |
| TN | $17.87 | 1 |
| TX | $18.40–$19.59 | 8 |
| UT | $18.54 | 1 |
| VA | $18.54–$20.89 | 2 |
| VI | $19.08 | 1 |
| VT | $18.32 | 1 |
| WA | $19.19–$20.74 | 2 |
| WI | $17.86 | 1 |
| WV | $18.83 | 1 |
| WY | $18.69 | 1 |
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
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 Vermont 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
105
- Locality
- Vermont
- Physician work
- 1.000
- Practice expense
- 0.990
- Malpractice
- 0.506
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 0.35 | × 1.000 | 0.3500 |
| Practice expense | 0.18 | × 0.990 | 0.1782 |
| Malpractice | 0.04 | × 0.506 | 0.0202 |
| Total RVUs | 0.5484 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Vermont$18.32
Office: (0.35 × 1 + 0.18 × 0.99 + 0.04 × 0.506) × $33.4009 = $18.32
Facility: (0.35 × 1 + 0.09 × 0.99 + 0.04 × 0.506) × $33.4009 = $15.34
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 Vermont
99446 · Office / nonfacility
$18.32
Effective 2026-10-01
The base rate is $1.68 higher than on 2025-10-01, moving from $16.64 to $18.32 (10.1%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
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
January 1, 2026
RVU26A
$16.64changed to$18.32
- 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 0.993 changed to 0.990
- Malpractice GPCI 0.518 changed to 0.506
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$17.13changed to$16.64
- Conversion factor 33.2875 changed to 32.3465
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$16.85changed to$17.13
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$17.33changed to$16.85
- 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 0.997 changed to 0.993
- Malpractice GPCI 0.543 changed to 0.518
January 1, 2023
RVU23A
$18.10changed to$17.33
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.15 changed to 0.14
- Practice expense GPCI 1.001 changed to 0.997
- Malpractice GPCI 0.569 changed to 0.543
Held through RVU23B, RVU23C, RVU23D.
January 1, 2022
RVU22A
$18.25changed to$18.10
- Conversion factor 34.8931 changed to 34.6062
Held through RVU22B, RVU22C, RVU22D.
January 1, 2021
RVU21A
$17.99changed to$18.25
- 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 1.008 changed to 1.001
- Malpractice GPCI 0.582 changed to 0.569
Held through RVU21B, RVU21C, RVU21D.
January 1, 2020
RVU20A
$18.16changed to$17.99
- 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 1.015 changed to 1.008
- Malpractice GPCI 0.595 changed to 0.582
Held through RVU20B, RVU20C, RVU20D.
January 1, 2019
RVU19A
No ratechanged to$18.16
Held through RVU19B, RVU19C, RVU19D.
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.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $18.32 | $15.34 | RVU26D |
| 2026-07-01 | $18.32 | $15.34 | RVU26C |
| 2026-04-01 | $18.32 | $15.34 | RVU26B |
| 2026-01-01 | $18.32 | $15.34 | RVU26A |
| 2025-10-01 | $16.64 | $16.64 | RVU25D |
| 2025-07-01 | $16.64 | $16.64 | RVU25C |
| 2025-04-01 | $16.64 | $16.64 | RVU25B |
| 2025-01-01 | $16.64 | $16.64 | RVU25A |
| 2024-10-01 | $17.13 | $17.13 | RVU24D |
| 2024-07-01 | $17.13 | $17.13 | RVU24C |
| 2024-04-01 | $17.13 | $17.13 | RVU24B |
| 2024-03-09 | $17.13 | $17.13 | RVU24AR |
| 2024-01-01 | $16.85 | $16.85 | RVU24A |
| 2023-10-01 | $17.33 | $17.33 | RVU23D |
| 2023-07-01 | $17.33 | $17.33 | RVU23C |
| 2023-04-01 | $17.33 | $17.33 | RVU23B |
| 2023-01-01 | $17.33 | $17.33 | RVU23A |
| 2022-10-01 | $18.10 | $18.10 | RVU22D |
| 2022-07-01 | $18.10 | $18.10 | RVU22C |
| 2022-04-01 | $18.10 | $18.10 | RVU22B |
| 2022-01-01 | $18.10 | $18.10 | RVU22A |
| 2021-10-01 | $18.25 | $18.25 | RVU21D |
| 2021-07-01 | $18.25 | $18.25 | RVU21C |
| 2021-04-01 | $18.25 | $18.25 | RVU21B |
| 2021-01-01 | $18.25 | $18.25 | RVU21A |
| 2020-10-01 | $17.99 | $17.99 | RVU20D |
| 2020-07-01 | $17.99 | $17.99 | RVU20C |
| 2020-04-01 | $17.99 | $17.99 | RVU20B |
| 2020-01-01 | $17.99 | $17.99 | RVU20A |
| 2019-10-01 | $18.16 | $18.16 | RVU19D |
| 2019-07-01 | $18.16 | $18.16 | RVU19C |
| 2019-04-01 | $18.16 | $18.16 | RVU19B |
| 2019-01-01 | $18.16 | $18.16 | RVU19A |
| 2018-10-01 | Separate payment rules apply | Separate payment rules apply | RVU18D |
| 2018-07-01 | Separate payment rules apply | Separate payment rules apply | RVU18C |
| 2018-04-01 | Separate payment rules apply | Separate payment rules apply | RVU18B |
| 2018-01-01 | Separate payment rules apply | Separate payment rules apply | RVU18AR1 |
| 2017-10-01 | Separate payment rules apply | Separate payment rules apply | RVU17D |
| 2017-07-01 | Separate payment rules apply | Separate payment rules apply | RVU17C |
| 2017-04-01 | Separate payment rules apply | Separate payment rules apply | RVU17B |
| 2017-01-01 | Separate payment rules apply | Separate payment rules apply | RVU17A |
| 2016-10-01 | Separate payment rules apply | Separate payment rules apply | RVU16D |
| 2016-07-01 | Separate payment rules apply | Separate payment rules apply | RVU16C |
| 2016-04-01 | Separate payment rules apply | Separate payment rules apply | RVU16B |
| 2016-01-01 | Separate payment rules apply | Separate payment rules apply | RVU16A |
| 2015-10-01 | Separate payment rules apply | Separate payment rules apply | RVU15D |
| 2015-07-01 | Separate payment rules apply | Separate payment rules apply | RVU15C |
| 2015-04-01 | Separate payment rules apply | Separate payment rules apply | RVU15B |
| 2015-01-01 | Separate payment rules apply | Separate payment rules apply | RVU15A |
| 2014-10-01 | Separate payment rules apply | Separate payment rules apply | RVU14D |
| 2014-07-01 | Separate payment rules apply | Separate payment rules apply | RVU14C |
| 2014-04-01 | Separate payment rules apply | Separate payment rules apply | RVU14B |
| 2014-01-01 | Separate payment rules apply | Separate payment rules apply | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Vermont rate applies
Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.
- Albany
- Alburgh
- Algiers
- Arlington
- Ascutney
- Bakersfield
- Barnet
- Barre
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
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