CPT code 99452: Referral coordination, requesting clinician, 30 minutes2026 Medicare rate & RVUs in Puerto Rico

In Puerto Rico, Medicare pays $37.18 for 99452 in the office and $31.10 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99452 nationwide

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

What 99452 covers

99452 represents the treating or requesting physician’s or qualified health care professional’s work to arrange an interprofessional consultation. That work can include reviewing and preparing the patient’s records, sending the clinical question and relevant information to a consultant, and coordinating the referral. It is used when the clinicians communicate through telephone, internet, or the electronic health record rather than conducting a joint face-to-face visit. The requesting clinician reports their own referral work; the consultant’s assessment and response are a separate service.

Report 99452 when the requesting clinician’s documented work reaches 30 minutes. Record the consultation request, the records and clinical information provided, communication or coordination performed, and total time. CMS assigns the service work and practice-expense values, with different practice-expense inputs for office and facility settings. The related consultant-side codes are selected according to the consultant’s service and time, not the requesting clinician’s referral time.

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 Puerto Rico compares for 99452

Across 109 of 109 payment localities, the office rate for 99452 runs from $34.57 in Arkansas to $48.80 in Alaska. Puerto Rico pays $37.18. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99452 rates by state

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

See 99452 in every payment locality

How the 99452 rate is calculated

Each of 99452’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 99452

99452 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.

Codes related to 99452

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

How 99452 has changed in Puerto Rico

Price 99452 for an earlier date of service

Where the Puerto Rico rate applies

Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.

• Aceitunas
• Adjuntas
• Aguada
• Aguadilla
• Aguas Buenas
• Aguas Claras
• Aguilita
• Aibonito

Browse all communities in Puerto Rico

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