99255

🎯 CPT Code 99255 Documentation & Billing Guide

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

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CPT 99255 - Inpatient Consultation (Level 5)

Description & Explanation: Used for an inpatient consultation requiring High complexity MDM. Reserved for severe, life-threatening, or highly complex 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: High.

• Time: 80 minutes.

Code Tree:

• Evaluation and Management

  • Inpatient or Observation Consultations

    • New or Established Patient

      • 99255: Inpatient consultation, high MDM or 80 min

Technical Data:

• WRVU (2025): ~4.00

• Global Period: XXX

• Assistant Payable: No

Clinical Examples:

1. Infectious Disease (Endocarditis): Patient with new murmur and fevers. ID consulted for suspected endocarditis. Multiple blood cultures, echo review, long-term IV antibiotic planning, coordination for possible valve surgery.

2. Neurology (Status Epilepticus): Patient with intractable seizures in ICU. Neurology manages multiple anti-epileptic drips and EEG monitoring.