cpt 99244, cpt code 99244, 99244 cpt code

CPT 99244 | Office/Outpatient Consultation | 40 + Minutes

CPT 99244 describes an office or outpatient consultation service provided by a healthcare provider to a new or established patient that requires a medically appropriate history and/or examination, a moderate level of medical decision-making, and at least 40 minutes spent on the encounter.

What Is CPT Code 99244?

CPT code 99244 is used for billing for an office or outpatient consultation service a provider provides to a new or established patient.

CPT 99244 can be used when the consultation service requires a medically appropriate history and/or examination and a moderate level of medical decision-making.

The provider must spend a minimum of 40 minutes on the encounter. This time includes both face-to-face and non-face-to-face activities.

The level of medical decision-making is moderate. This means that the consultation service addresses a moderate complexity of problems and involves a moderate amount of data review and analysis with a moderate risk of complications, morbidity, and mortality related to patient management.

CPT code 99244 is used for billing for a specific consultation service. This differs from other consultation services in scope, duration, and level of medical decision-making.

Description

The CPT book describes CPT code 99244 as: “Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and a moderate level of medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.”

Procedure

The provider evaluates and manages patients during an office or outpatient consultation service.

A healthcare professional, social worker, or insurance company must request the service. 

In addition, the provider must communicate with the requesting source to share their findings and any information related to the services provided.

The service must involve either moderate medical decision-making or a minimum of 40 minutes spent on the encounter on a single date.

The total time includes both face-to-face and non-face-to-face activities. The level of medical decision-making is determined by the number and complexity of problems addressed, the amount and complexity of data reviewed and analyzed, and the risk of complications, morbidity, and mortality related to patient management.

How To Use CPT 99244

Make sure it is the appropriate code for the consultation service before you bill CPT 99244. 

CPT code 99252, CPT code 99253, CPT code 99254, and CPT code 99255 can be used for observation or inpatient consultations.

Before billing for the service, confirm with the payer regarding their coverage and use policies for CPT 99244.

When performing the consultation service, include a medically appropriate history and/or physical examination, if required.

The provider should determine the necessary level of history and examination, which does not affect the selection of the code.

However, ensure that all services performed are appropriately documented in the medical record.

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