99252

🎯 CPT Code 99252 Documentation & Billing Guide

Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant

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CPT 99252 - Inpatient Consultation (Level 2)

Description & Explanation: Used for an inpatient consultation requiring a medically appropriate history/exam and Straightforward MDM.

Warning

Important Payer Note: CPT codes 99252 -99255 (Inpatient Consultations) are not recognized by Medicare (and many private payers aligning with CMS). For Medicare patients, you must typically bill these as Initial (9922x) or Subsequent (9923x) Hospital Care, even if you are a consultant.

• Definition of Consultation: Requires a specific request from another physician/appropriate source to recommend care for a specific condition.

• MDM: Straightforward.

• Time: 20 minutes (total time on date of encounter).

• Note: 99251 was deleted; 99252 is now the lowest level inpatient consult code.

Code Tree:

• Evaluation and Management

  • Inpatient or Observation Consultations

    • New or Established Patient

      • 99252: Inpatient consultation, straightforward MDM or 20 min

Technical Data:

• WRVU (2025): ~1.25

• Global Period: XXX

• Assistant Payable: No (Indicator 9)

• HCC Information: N/A

Bundling & Edits:

• Exclusive: Medicare requires 9922x/9923x instead.

• Included: Report sent back to the requesting physician.

Clinical Examples:

1. Dermatology Consult: Patient admitted for cellulitis has a separate, unrelated benign rash on the arm. Dermatologist consulted to evaluate. Diagnosis: Seborrheic keratosis (minor, stable).

2. Podiatry Consult: Diabetic patient admitted for pneumonia. Podiatry asked to trim mycotic nails (routine).