99253

🎯 CPT Code 99253 Documentation & Billing Guide

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

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CPT 99253 - Inpatient Consultation (Level 3)

Description & Explanation: Used for an inpatient consultation requiring Low complexity MDM. This is the standard “low complexity” consult.

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.

• MDM: Low.

• Time: 35 minutes.

Code Tree:

• Evaluation and Management

  • Inpatient or Observation Consultations

    • New or Established Patient

      • 99253: Inpatient consultation, low MDM or 35 min

Technical Data:

• WRVU (2025): ~2.27

• Global Period: XXX

• Assistant Payable: No

Clinical Examples:

1. Ortho Consult (Stable): Patient admitted for syncope found to have a chronic, stable rotator cuff tear. Orthopedics consulted for long-term plan (PT vs surgery later).

2. Psych Consult (Uncomplicated): Patient admitted for surgery, requesting restart of home anti-depressants. Psychiatrist reviews history, restarts meds, no acute safety risk.