$19.19–$22.36
99446 includes both verbal and written communication and covers 5–10 minutes. Choose 99451 for a written-report service with at least five minutes of consultative work when no verbal discussion is provided.
On this page
CMS RVU26D · Effective 2026-10-01
99451 E-consult Medicare reimbursement rates in California
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. Compare 99451 office and facility rates across CMS payment localities in California.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99451 in California?
California has 29 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 29 payment areas shown below, using the same CMS release.
Office / nonfacility
$36.02–$41.78
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $5.76 per service.
Facility setting
$30.16–$34.07
29 of 29 localities have a supported rate.
Lowest: Chico
Highest: San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
A spread of $3.91 per service.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99451 pays more and less in California
29 payment localities
$36.02 to $41.78
Interprofessional consultation
About 99451: Interprofessional consultation with written report
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.
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.
Where the value comes from
- Work RVU0.70 · 66%
- Practice expense (office) RVU0.31 · 29%
- Malpractice RVU0.05 · 5%
106.7K
Medicare services in 2024 · #537 by national volume
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.
99451 compared with similar codes
Office rates for California, from the same CMS release.
$77.53–$90.66
99449 includes verbal and written communication for 31 minutes or more. 99451 is selected by the written-report service structure, not by that 31-minute threshold.
$37.85–$44.19
99452 describes referral-related work by the treating or requesting professional. 99451 describes the consulting physician’s review and written recommendations.
Compare 99451 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
29 of 29 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Bakersfield | Office $36.19 | Facility $30.33 |
| Chico | Office $36.02 | Facility $30.16 |
| El Centro | Office $36.03 | Facility $30.17 |
| Fresno | Office $36.02 | Facility $30.16 |
| Hanford-Corcoran | Office $36.02 | Facility $30.16 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office $37.70 | Facility $31.38 |
| Madera | Office $36.02 | Facility $30.16 |
| Merced | Office $36.02 | Facility $30.16 |
| Modesto | Office $36.02 | Facility $30.16 |
| Napa | Office $39.35 | Facility $32.31 |
| Oxnard-Thousand Oaks-Ventura | Office $37.31 | Facility $31.00 |
| Redding | Office $36.02 | Facility $30.16 |
| Rest Of California | Office $36.02 | Facility $30.16 |
| Riverside-San Bernardino-Ontario | Office $36.57 | Facility $30.72 |
| Sacramento-Roseville-Folsom | Office $37.16 | Facility $30.94 |
| Salinas | Office $37.00 | Facility $30.81 |
| San Diego-Chula Vista-Carlsbad | Office $37.37 | Facility $30.98 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office $40.97 | Facility $33.43 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office $40.91 | Facility $33.38 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office $41.78 | Facility $34.07 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office $41.55 | Facility $33.84 |
| San Luis Obispo-Paso Robles | Office $36.47 | Facility $30.38 |
| Santa Cruz-Watsonville | Office $37.35 | Facility $30.85 |
| Santa Maria-Santa Barbara | Office $37.00 | Facility $30.77 |
| Santa Rosa-Petaluma | Office $37.69 | Facility $31.13 |
| Stockton | Office $36.02 | Facility $30.16 |
| Vallejo | Office $39.27 | Facility $32.22 |
| Visalia | Office $36.02 | Facility $30.16 |
| Yuba City | Office $36.02 | Facility $30.16 |
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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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,11599448,,Ntrprof ph1/ntrnet/ehr 21-30,A,,1.05,0.56,,0.29,,0.09,1.70,1.43,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,11699449,,Ntrprof ph1/ntrnet/ehr 31/>,A,,1.40,0.76,,0.38,,0.12,2.28,1.90,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,11799450,,Basic life disability exam,N,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
13,11899451,,Ntrprof ph1/ntrnet/ehr 5/>,A,,0.70,0.31,,0.15,,0.05,1.06,0.90,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,11999452,,Ntrprof ph1/ntrnet/ehr rfrl,A,,0.70,0.36,,0.18,,0.05,1.11,0.93,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12099453,,Rem mntr physiol param setup,A,,0.00,0.63,,0.63,NA,0.02,0.65,0.65,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,12199454,,Rem mntr physiol param 16-30,A,,0.00,1.55,,1.55,NA,0.01,1.56,1.56,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00