99254

🎯 CPT Code 99254 Documentation & Billing Guide

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

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CPT 99254 - Inpatient Consultation (Level 4)

Description & Explanation: Used for an inpatient consultation requiring Moderate complexity MDM. This is a very common code for specialists seeing patients with active exacerbations or new diagnostic problems.

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: Moderate.

• Time: 55 minutes.

Code Tree:

• Evaluation and Management

  • Inpatient or Observation Consultations

    • New or Established Patient

      • 99254: Inpatient consultation, moderate MDM or 55 min

Technical Data:

• WRVU (2025): ~3.29

• Global Period: XXX

• Assistant Payable: No

Clinical Examples:

1. Cardiology Consult (Afib): Patient admitted for sepsis goes into RVR (Afib). Cardiology consulted. Meds ordered (Beta blockers), echo reviewed, rate control strategy discussed.

2. Nephrology Consult (AKI): Patient with creatinine bump from 1.0 to 2.5. Nephrology consults to manage fluids and review meds.