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CPT code 99451: E-consult, written report, 5+ minutes2026 Medicare rate & RVUs in New Hampshire

A consulting physician reviews a patient's clinical information and sends written assessment and recommendations to the treating professional after at least five minutes of consultative work.

CMS RVU26DEffective Oct 1, 2026One payment locality106.7K Medicare services in 2024

In New Hampshire, Medicare pays $35.62 for 99451 in the office and $30.06 when it’s performed in a hospital or facility.

$35.62Office (non-facility)
$30.06Hospital or facility
+0.6%vs the national office rate ($35.40)

Check a contract rate as a % of Medicare · 99451 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 99451 for the payment locality that covers the ZIP.

On this page 11 sections
  1. Rate in New Hampshire
  2. What 99451 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 99451 covers

A treating physician or other qualified health care professional may request a specialist’s advice about a patient’s clinical question without arranging a patient visit with that specialist. The consultant reviews the relevant record and provides an assessment and recommendations in a written report. For example, a primary care physician might ask a cardiologist to review a patient’s symptoms and available cardiac test results and advise on next steps. The service is an exchange between professionals, not a face-to-face consultation with the patient.

Report 99451 when the consultative physician provides the written report and performs at least five minutes of medical consultative work. The record should identify the request and clinical question, information reviewed, consultant’s assessment and recommendations, written communication to the treating professional, and time spent. Document the patient’s consent to the interprofessional consultation. Distinguish this service from codes 99446–99449, which include verbal as well as written communication and use specific time intervals.

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 New Hampshire compares for 99451

Across 109 of 109 payment localities, the office rate for 99451 runs from $33.14 in Arkansas to $47.02 in Alaska. New Hampshire pays $35.62. The RVUs are the same everywhere; the geographic indexes change the dollars.

99451 in New Hampshire vs other payment areas
  1. New Hampshire · this page$35.62
  2. Los Angeles, CA · California$37.70+$2.08
  3. Washington, DC area · District of Columbia$38.70+$3.08
  4. Miami, FL · Florida$38.38+$2.76
  5. Chicago, IL · Illinois$37.78+$2.16
  6. Manhattan, NY · New York$39.56+$3.94
  7. Alaska · Alaska$47.02+$11.40

Other areas in New Hampshire first, then benchmark localities. Bars start at $0.

Every other payment area

99451 in every other Medicare payment locality
Payment localityOfficeFacility
AlabamaAlabama$33.39$28.71
ArkansasArkansas$33.14$28.54
ArizonaArizona$34.84$29.67
Bakersfield, CACalifornia$36.19$30.33
Chico, CACalifornia$36.02$30.16
El Centro, CACalifornia$36.03$30.17
Fresno, CACalifornia$36.02$30.16
Hanford, CACalifornia$36.02$30.16

99451 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.

$33.14

$47.02

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

View every state and territory as a table
99451 office rate range by state
State / territoryOffice rate rangeLocalities
AK$47.021
AL$33.391
AR$33.141
AZ$34.841
CA$36.02–$41.7829
CO$35.981
CT$37.021
DC$38.701
DE$35.231
FL$35.79–$38.383
GA$34.61–$35.982
GU$36.121
HI$36.121
IA$33.521
ID$33.701
IL$35.44–$37.784
IN$33.791
KS$33.581
KY$34.111
LA$34.14–$35.022
MA$35.99–$38.192
MD$35.63–$38.703
ME$33.95–$34.702
MI$34.72–$36.192
MN$34.531
MO$33.93–$34.913
MS$33.531
MT$35.401
NC$34.111
ND$34.411
NE$33.571
NH$35.621
NJ$37.45–$38.652
NM$34.881
NV$35.141
NY$34.39–$40.295
OH$34.521
OK$33.921
OR$34.87–$36.502
PA$34.46–$36.572
PR$35.491
RI$36.011
SC$34.371
SD$34.301
TN$33.691
TX$34.35–$36.158
UT$34.611
VA$34.74–$38.702
VI$35.491
VT$34.481
WA$35.86–$38.622
WI$33.811
WV$34.771
WY$34.971

See 99451 in every payment locality

How the 99451 rate is calculated

Each of 99451’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 · 99451

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.70

0.70 RVUs× 1.000 GPCI

Practice expense0.31

0.31 RVUs× 1.000 GPCI

Malpractice0.05

0.05 RVUs× 1.000 GPCI

Adjusted RVUs

1.0600

Conversion factor

$33.4009

Medicare rate

$35.40

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

The exact New Hampshire inputs and CMS source lines

PPRRVU2026_Oct_nonQPP.csv

13,118

Code
99451
Physician work
0.70
Practice expense
0.31
Malpractice
0.05

GPCI2026.csv

74

Locality
New Hampshire
Physician work
1.000
Practice expense
1.041
Malpractice
0.875
Office calculation for 99451 in New Hampshire
ComponentRVULocality factorAdjusted
Physician work0.70× 1.0000.7000
Practice expense0.31× 1.0410.3227
Malpractice0.05× 0.8750.0438
Total RVUs1.0665
Conversion factor× 33.4009

Office rate, New Hampshire$35.62

Office: (0.7 × 1 + 0.31 × 1.041 + 0.05 × 0.875) × $33.4009 = $35.62

Facility: (0.7 × 1 + 0.15 × 1.041 + 0.05 × 0.875) × $33.4009 = $30.06

Open 99451 in the RVU calculator

Payment rules and modifiers for 99451

99451 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 · 99451

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

$35.40

Non-facility (office)
$35.40
Facility
$30.06

Higher because the practice carries its own overhead.

Codes related to 99451

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

Codes related to 99451
CodeHow it relatesOffice range, New Hampshire
Same family
99446Consultation, 5–10 minutesInterprofessional consultation with verbal and written communication, for 5–10 minutes.$19.12
99447Interprofessional consult, 11–20 minutesInterprofessional consultation with verbal and written communication, for 11–20 minutes.$38.29
99448Interprofessional consultation, 21–30 minutesInterprofessional consultation with verbal and written communication, for 21–30 minutes.$57.17
99449Interprofessional consult, 31 minutes or moreInterprofessional consultation with verbal and written communication, for 31 minutes or more.$76.69
Often billed with
99452Referral coordination, requesting clinician, 30 minutesMay describe the treating professional’s separately documented work coordinating an interprofessional referral.$37.36

How 99451 has changed in New Hampshire

99451 · Office / nonfacility

$35.62

Effective 2026-10-01

The base rate is $2.45 higher than on 2025-10-01, moving from $33.17 to $35.62 (7.4%).

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

    $33.17changed to$35.62

    • Conversion factor 32.3465 changed to 33.4009
    • Practice expense RVU 0.28 changed to 0.31
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 1.034 changed to 1.041
    • Malpractice GPCI 0.898 changed to 0.875

    Held through RVU26B, RVU26C, RVU26D.

  2. January 1, 2025

    RVU25A

    $34.78changed to$33.17

    • Conversion factor 33.2875 changed to 32.3465
    • Practice expense RVU 0.29 changed to 0.28
    • Malpractice RVU 0.05 changed to 0.04

    Held through RVU25B, RVU25C, RVU25D.

  3. March 9, 2024

    RVU24AR

    $34.21changed to$34.78

    • Conversion factor 32.7442 changed to 33.2875

    Held through RVU24B, RVU24C, RVU24D.

  4. January 1, 2024

    RVU24A

    $35.83changed to$34.21

    • Conversion factor 33.8872 changed to 32.7442
    • Practice expense RVU 0.31 changed to 0.29
    • Malpractice RVU 0.04 changed to 0.05
    • Practice expense GPCI 1.036 changed to 1.034
    • Malpractice GPCI 0.907 changed to 0.898

  5. January 1, 2023

    RVU23A

    $36.59changed to$35.83

    • Conversion factor 34.6062 changed to 33.8872
    • Practice expense RVU 0.30 changed to 0.31
    • Malpractice RVU 0.05 changed to 0.04
    • Practice expense GPCI 1.038 changed to 1.036
    • Malpractice GPCI 0.917 changed to 0.907

    Held through RVU23B, RVU23C, RVU23D.

  6. January 1, 2022

    RVU22A

    $36.53changed to$36.59

    • Conversion factor 34.8931 changed to 34.6062
    • Practice expense RVU 0.29 changed to 0.30

    Held through RVU22B, RVU22C, RVU22D.

  7. January 1, 2021

    RVU21A

    $37.94changed to$36.53

    • Conversion factor 36.0896 changed to 34.8931
    • Practice expense GPCI 1.042 changed to 1.038
    • Malpractice GPCI 0.984 changed to 0.917

    Held through RVU21B, RVU21C, RVU21D.

  8. January 1, 2020

    RVU20A

    $38.04changed to$37.94

    • Conversion factor 36.0391 changed to 36.0896
    • Practice expense GPCI 1.045 changed to 1.042
    • Malpractice GPCI 1.050 changed to 0.984

    Held through RVU20B, RVU20C, RVU20D.

  9. January 1, 2019

    RVU19A

    No ratechanged to$38.04

    Held through RVU19B, RVU19C, RVU19D.

  10. January 1, 2013

    RVU13AR

    Earliest loaded release: No rate

    Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D.

Rates in every CMS release
Effective fromOfficeFacilityCMS release
2026-10-01$35.62$30.06RVU26D
2026-07-01$35.62$30.06RVU26C
2026-04-01$35.62$30.06RVU26B
2026-01-01$35.62$30.06RVU26A
2025-10-01$33.17$33.17RVU25D
2025-07-01$33.17$33.17RVU25C
2025-04-01$33.17$33.17RVU25B
2025-01-01$33.17$33.17RVU25A
2024-10-01$34.78$34.78RVU24D
2024-07-01$34.78$34.78RVU24C
2024-04-01$34.78$34.78RVU24B
2024-03-09$34.78$34.78RVU24AR
2024-01-01$34.21$34.21RVU24A
2023-10-01$35.83$35.83RVU23D
2023-07-01$35.83$35.83RVU23C
2023-04-01$35.83$35.83RVU23B
2023-01-01$35.83$35.83RVU23A
2022-10-01$36.59$36.59RVU22D
2022-07-01$36.59$36.59RVU22C
2022-04-01$36.59$36.59RVU22B
2022-01-01$36.59$36.59RVU22A
2021-10-01$36.53$36.53RVU21D
2021-07-01$36.53$36.53RVU21C
2021-04-01$36.53$36.53RVU21B
2021-01-01$36.53$36.53RVU21A
2020-10-01$37.94$37.94RVU20D
2020-07-01$37.94$37.94RVU20C
2020-04-01$37.94$37.94RVU20B
2020-01-01$37.94$37.94RVU20A
2019-10-01$38.04$38.04RVU19D
2019-07-01$38.04$38.04RVU19C
2019-04-01$38.04$38.04RVU19B
2019-01-01$38.04$38.04RVU19A
2018-10-01Not in this releaseNot in this releaseRVU18D
2018-07-01Not in this releaseNot in this releaseRVU18C
2018-04-01Not in this releaseNot in this releaseRVU18B
2018-01-01Not in this releaseNot in this releaseRVU18AR1
2017-10-01Not in this releaseNot in this releaseRVU17D
2017-07-01Not in this releaseNot in this releaseRVU17C
2017-04-01Not in this releaseNot in this releaseRVU17B
2017-01-01Not in this releaseNot in this releaseRVU17A
2016-10-01Not in this releaseNot in this releaseRVU16D
2016-07-01Not in this releaseNot in this releaseRVU16C
2016-04-01Not in this releaseNot in this releaseRVU16B
2016-01-01Not in this releaseNot in this releaseRVU16A
2015-10-01Not in this releaseNot in this releaseRVU15D
2015-07-01Not in this releaseNot in this releaseRVU15C
2015-04-01Not in this releaseNot in this releaseRVU15B
2015-01-01Not in this releaseNot in this releaseRVU15A
2014-10-01Not in this releaseNot in this releaseRVU14D
2014-07-01Not in this releaseNot in this releaseRVU14C
2014-04-01Not in this releaseNot in this releaseRVU14B
2014-01-01Not in this releaseNot in this releaseRVU14A
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 99451 for an earlier date of service

Where the New Hampshire rate applies

New Hampshire is a Medicare payment area, not a city. Our Census mapping connects it to 100 cities and communities in New Hampshire. Some span more than one payment area; confirm with the service ZIP.

  • Alton
  • Amherst
  • Antrim
  • Ashland
  • Bartlett
  • Belmont
  • Bennington
  • Berlin

Browse all communities in New Hampshire

99451 billing questions

When should 99451 be chosen instead of 99446?

Use 99451 when the consultant reports the assessment and recommendations in writing without the verbal discussion included in 99446. Both codes include a five-minute threshold, so the communication provided—not just elapsed time—distinguishes them.

Does 99451 require a discussion with the treating professional?

No. The service includes a written report to the treating or requesting professional; codes 99446–99449 describe services that include verbal and written communication.

What should the consultant document?

Document the referring professional’s question, records or clinical information reviewed, the assessment and recommendations, the written report, and at least five minutes of consultative work.

Is patient consent part of the documentation?

Yes. Document the patient’s consent to the interprofessional consultation.

Can 99451 be reported for less than five minutes?

No. The service requires at least five minutes of medical consultative time.

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 99451PPRRVU2026_Oct_nonQPP.csv, line 13,118 (RVU26D)
Geographic factors for New HampshireGPCI2026.csv, line 74 (RVU26D)

Open CMS sourceHow we calculate rates

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