CPT code 99451: E-consult2026 Medicare rate & RVUs in Texas
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.
Medicare pays $34.35–$36.15 for 99451 in the office in Texas, from Beaumont to Houston. 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.
On this page 9 sections
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.
Where 99451 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$34.35 to $36.15
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | $35.86 | $30.21 |
| Beaumont | $34.35 | $29.49 |
| Brazoria | $35.13 | $29.84 |
| Dallas | $35.34 | $30.01 |
| Fort Worth | $35.25 | $29.99 |
| Galveston | $35.23 | $29.93 |
| Houston | $36.15 | $30.84 |
| Rest Of Texas | $34.71 | $29.64 |
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
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.
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.
99451 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99446Consultation
- 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.
- 99449Interprofessional consult
- 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.
- 99452Referral coordination
- 99452 describes referral-related work by the treating or requesting professional. 99451 describes the consulting physician’s review and written recommendations.
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
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