99241 CPT Code (2022) | Description, Procedure, Guidelines & Reimbursement
You can report CPT 99241 for consultation services provided at the request of another health provider. The three components described by the official description need to be met to bill this code appropriately.
The key components are an addition to the procedure’s medical necessity.
1. Description
CPT code 99241 is defined by the book of CPT as follows: “Office consultation for a new or established patient, which requires these three key components:
- A problem-focused history;
- A problem-focused examination; and
- Straightforward medical decision-making.
Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient’s and/or family’s needs.
Usually, the presenting problem(s) are self limited or minor. Typically, 15 minutes are spent face-to-face with the patient and/or family.”
2. Procedure
For CPT code 99241, the provider spends an average of 15 minutes face–to–face with a new or established patient.
Three out of three key components must be met to support the service level. The appropriate E/M service level is based on the medical necessity of performing the key components and also reviewing documentation of the key E/M criteria of the;
- exam;
- history; and
- medical decision making, MDM, elements.
Use time as the controlling factor to report an office or other outpatient visit if more than 50% of the total visit time comprises counseling and care coordination.
Three key components for the 99241 CPT code are:
- Straightforward medical decision–making;
- A problem–focused examination; and
- A problem–focused history.
The presenting problem or problems are often self–limited or have minor severity.
3. Reimbursement
You can use three units to prove the medical necessity of the procedure described by CPT code 99241.
Below you can find the reimbursement rates for CPT 99241.
| Costs | RUVs | |
| Facility | $34.28 | 0.99057 |
| Non-Facility | $51.36 | 1.48407 |
4. Billing Guidelines
It is appropriate to append a modifier to CPT code 99241 when you report this code as a separate and significant E/M service, including outpatient E/M visits, and on the same day as another procedure or service.
Be aware that CPT 99241 will be deleted in 2023.
5. Resources
https://medicaid.ncdhhs.gov/media/4909/download
