Billing code 99452: Referral coordinationMedicare rate & RVUs in Utah
Reports 30 minutes of referral work by the treating clinician, including preparing records and coordinating an interprofessional consultation with another clinician.
Medicare pays $36.18 for 99452 in the office in Utah (Utah). 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 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.
99452 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | $36.18 | $30.53 |
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.
How the rate is built · 99452
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.70Practice expense 0.36Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99452
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
$37.07
The facility rate would be $31.06 (+$6.01). In a facility, the facility bills its own costs separately.
99452 compared with similar codes
Compare codes
99452 vs 99446 vs 99451 vs 99449: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99446Consultation
- 99452 is reported by the treating or requesting clinician for referral coordination. 99446 is a consultant-side service with its own time criteria.
- 99451E-consult
- Use 99452 for the requester’s 30 minutes of referral work; 99451 describes the consultant’s assessment and response.
- 99449Interprofessional consult
- 99449 reports the consultant’s service at its applicable time level. 99452 reports the requesting clinician’s referral and coordination work.
99452 billing questions
Who reports 99452?
The treating or requesting physician or qualified health care professional reports it for their referral and coordination work. The consulting clinician reports a consultant-side code for their own work when appropriate.
How much time is required?
The requesting clinician must document 30 minutes of referral-service work. Count the clinician’s own work preparing and coordinating the consultation, not the consultant’s time.
Can 99452 be reported with 99446 or 99451?
They represent different clinicians’ work: 99452 is for the requester, while 99446–99449 and 99451 describe consultant-side services. When both clinicians perform and document their respective services, each selects the code matching their role and service.
Is 99452 the right code for the consultant’s report?
No. The requesting clinician uses 99452 for referral coordination; the consultant uses 99446–99449 or 99451 for the consultant’s assessment and response, as applicable.
What documentation supports 99452?
Document the clinical question, the information sent to the consultant, the requesting clinician’s referral and coordination activities, and the 30 minutes of work.
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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