CPT code 99446: Consultation2026 Medicare rate & RVUs in Pennsylvania
A consultant physician reviews a case and advises the treating clinician through a brief remote discussion and written report lasting 5–10 minutes.
Medicare pays $18.47–$19.75 for 99446 in the office in Pennsylvania, from Rest of Pennsylvania to Metropolitan Philadelphia, PA. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 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.
Where 99446 pays more and less in Pennsylvania
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Philadelphia, PA | $19.75 | $16.62 |
| Rest of Pennsylvania | $18.47 | $15.71 |
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.
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.
99446 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99447Interprofessional consult
- Both represent verbal interprofessional consultation with review and a written report. Choose 99446 for 5–10 minutes and 99447 for 11–20 minutes.
- 99451E-consult
- 99446 includes a verbal discussion with the treating or requesting clinician. 99451 is the written-report-only pathway for the consultant’s remote review.
- 99452Referral coordination
- 99446 is reported by the consultant physician providing advice. 99452 represents the requesting clinician’s work coordinating the referral and preparing the case.
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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