99244 CPT Code (2023) | Description, Guidelines, Reimbursement, Modifiers & Examples
99244 CPT code is used to report services when office and other outpatient consultation services are performed by the physician or other qualified healthcare professional for consultation purposes.
CPT code 99244It is used for the physician’s advice, or opinion regarding treatment, management options, diagnosis, or transfer of the patient to the other facility at the request of primary care physician or by the provider who is currently treating.
99244 CPT Code | Description
If a patient’s insurance or payer wants another opinion for the patient’s treatment or management option.
There are the following steps that need to be followed for consultation service:
Consultation requests and findings must be discontented with the patient’s medical records.
Consulting Physician can initiate further diagnostic services on the same day of consultation or at a follow-up visit.
The other separate services were performed in combination with Consultation service CPT 99244. Consultation service is separately reportable.
There are four other CPT codes (99241, 99242, 99243, 99245) available of the same category in conjunction with CPT 99244.
The most basic consultation service is reported with CPT 99241, which requires 15 minutes of total time spent by the provider if Code selection is time-based or Straightforward MDM with problem-focused history and exam.
CPT 99242 requires 30 minutes of whole time spent by the provider if Code selection is time-based or straightforward MDM with an expanded problem-focused history.
CPT 99243 requires 40 minutes of total time spent by the provider if Code selection is time-based or low-level MDM with detailed history and exam.
CPT 99245 requires 80 minutes of full-time spent by the provider if Code selection is time-based or High-level MDM with a comprehensive history and exam.
CPT code 99244 requires 60 minutes of total time spent by the provider if Code selection is time-based or moderate to high severity MDM with a comprehensive history and exam.
CPT code 99244 does not differentiate between established and new patient visits. A new patient is someone who did not receive any professional services from a physician or other qualified healthcare professional with the same group or specialty within the past three years.
An established patient has received assistance in the past three years by the same physician or same group or specialty.
CPT (Current Procedural Terminology) 99244 will be reported when a patient receives a consultation service regardless of whether a new or established patient from the provider or other qualified healthcare professional, including all the three key components of evaluation and management CPT codes.
This service can be reported in both ways if time is mentioned on the medical chart. It typically requires 60 minutes of total time spent by the provider.
There is the following component that must meet to report the 99244 CPT code:
- Face to face visit with patient and/or family
- Require 60 minutes of total time spent by the provider if time is mentioned on the chart
- The patient’s condition must reflect the nature of presenting problem to report this service
- It requires a comprehensive history
- Comprehensive exam
- A moderate level of medical decision-making will be needed.
Reimbursement
The cost and RUVS of CPT 99244 are as follows:
Facility: Cost 162.43$ RUVS 4.s69371
Non-Facility: Cost 195.77$ RUVS 5.65721
If a visit (99244) is placed as telemedicine, then it is appropriate to append modifier 95 for telehealth services for physician services.
In addition, the HCPCS code Q3014 will be reported when the patient receives telehealth services from the hospital if a patient cannot be relocated to the office or home.
99244 CPT Code Modifiers
The most frequent modifiers used with CPT 99244 are 24, 25, and 95.
Modifier 25 will be appended with CPT 99244 when services are done in conjunction with other services that are not normally billed together on the same day. While 24 will be appended with services done in the postoperative period with unrelated procedures or services.
Modifier 95 will be attached to CPT 99244 if service is provided as a telehealth visit.
Modifier 57 will be attached to CPT 99244 if physicians plan to do surgery on the same service date when the E/M visit is done.
Coding & Billing Guidelines For CPT 99244
CPT code 99244 requires 3 out of 3 components which are as follows:
A comprehensive history: It requires at least 4 HPI elements, 10 ROS systems, and two history components are required 2 out of 3 components (PFSH).
A comprehensive examination requires eight-plus systems as per 95 documentation and nine systems with two-plus bullets required as 97 documentations.
Moderate to High severity MDM: It requires at least 2 out of three components of MDM that must be met on that basis of risk, diagnostic or treatment, Data management services like Medicine, Laboratory, Medicine, Medicine, Medicine, review, counseling, Interpretation of services. If time is mentioned in the medical notes, then it is appropriate to bill based on time instead of MDM, which typically requires 60 minutes consultation to the patient by the consultant,
Consultation CPT Code 99244 is not accepted by Medicare. It is appropriate to the bill as office or other outpatient hospital visit codes (99202-99499)
If patient diagnoses and the problem are assumed before or at the initial evaluation, then consultation CPT codes will not be reported.
CPT 99244 will not be reported for inpatient consultation services. Inpatient consultation services will be reported with 99251-99255 CPT codes. While the outpatient hospital or office visits will be reported with E/M CPT codes (99202-99215)
Emergency CPT codes (99281-99285) are separately reportable when performed with CPT 99244.
If the patient/family prompts consultation service, then CPT 99244 is not appropriate to the bill. It would be reported with office, domiciliary/rest home, or home visit CPT codes (99202-99215, 99324-99337, 99341-99350).
Q3014 is applicable when the hospital provides telemedicine service as an origin site to other outpatient hospital patients.
All outpatient consultations provided in the office, outpatient or other ambulatory facilities, domiciliary/rest home, emergency department, patient’s home, and hospital observation
The 99244 CPT code includes the following services:
Documentation is needed for consultation requests and must be in the patients’ medical records. One provider can bill only one consultancy in one day.
Provision by the physician or qualified nonphysician practitioner whose suggestion, direction, or counsel, advice, opinion, recommendation, etc., requested for evaluating/treating patients if primary care provider or attending provider does not have knowledge and expertise in that specialty.
Provision authored report, findings/recommendations from consultant to referring physician.
Modifier 32 will be appended for the third-party Third-party mandated consultation.
CPT Code 99244 Medicare
Medicare does not accept the consultation CPT code 99244 after 2010. It would be appropriate to bill with office or other outpatient visit CPT codes (99202-99215).
CPT 99244 Consultation Code
Consultation codes CPT 99244, 99245 and 99241 are used to represent second opinion visits.
Consultation is a sort of assessment and management service given by a physician at the request of another physician or other appropriate source, either to recommend treatment for a particular condition or problem, or to define whether they should be responsible for ongoing treatment.
It does not serve as a CPT code of conduct for assessment and management, or related advice.
When to code an evaluation and management (E / M) service as advice is one of the most commonly asked questions: How can you define if an E / M service is advice?
The discreet comparison between a consultation and an office visit is that the consultation is performed by a doctor whose opinion or advice to evaluate and / or treat a particular problem is sought from another doctor.
An office visit is considered a consultation only if the following criteria are met for the use of a consultation CPT code:
The consultation is conducted at the request of another physician or a suitable source who is seeking assessment advice and / or handling of a certain problem.
The request for advice and the logic for the request must be noted in the patient’s medical history.
Post consultation, the physician must arrange a written report which is sent to the referring physician.
If all of the previous requirements are not met, the applicable practice or other E / M service for outpatient (CPT 99201 – 99215) or inpatient (CPT 99221 – 99223) should be reported in lieu of a consultation code.
99244 CPT Code Examples
Below are examples of when it is appropriate to use CPT code 99244.
Example 1
A 36-Year-old male presents to the emergency department with a past medical history of chronic kidney disease, chronic heart failure, and Hypertension.
He currently has dialysis and fever, nausea, bilious vomiting, and epigastric pain that started yesterday morning and presented to the emergency department.
The patient’s condition was not getting stable after treatment and medication. Abdominal pain started unprovoked, but he denies trauma.
Pt endorses SOB at rest, 91% O2 on room air. He also endorses HA and weakness. Pt denies haematuria, dysuria, diarrhea, changes in vision or hearing.
The patient completed dialysis yesterday and did not take any medications for SX. The physician consulted with a Nephrologist for further treatment and management of this patient.
The consulting physician ordered an Ultrasound of the kidney, MRI, and CT of the Abdomen and Pelvis. The studies show that patients needed immediate dialysis within 24 hours.
Example 2
A 42-year-old male presents to the office for Gastrentrogist consultation service. The patient was presented to the hospital outpatient department yesterday with rectal bleeding from 4-5 days.
He is unable to eat anything. The 10 points ROS was completed and reviewed.
The physical exam revealed abdominal distention and fecal impaction in the abdominal region.
The physician sent him for consultation service with the gastroenterologist. He further investigates the patient’s condition by ordering CT, MRI of the Abdomen, and Labs test.
The studies suggest that the patient had colon polyps and needed immediate colonoscopic surgery. The patient has been scheduled for next week’s Colonoscopy.
Example 3
A 78-year-old male presents to the office for pain in both hips for two weeks. The patient is not getting relief from any medicine. The pain is getting worse by movement and by daily routine. Exam revealed that the patient has to swell in both lower extremities.
The physician ordered the CT, MRI, and X-ray of both hips. CT revealed that the patient has Osteoarthritis of both hips. The physician consulted with Orthopedics Dr. ABC for further treatment options.
The consultant prescribed some medication for pain relief and scheduled next week’s appointment to check if the medication was working or not.
More Examples
Example 1
Initial office consultation for a 28-year-old male, HIV+, with a recent change in visual acuity. (Ophthalmology)
Example 2
Initial office consultation for a 15-year-old male with failing grades, suspected drug abuse. (Pediatrics)
Example 3
Initial office consultation for a 36-year-old factory worker, status four months post-occupational low back injury and requires management of intractable low back pain. (Pain Medicine)
Example 4
Initial office consultation for a 45-year-old female with a history of chronic arthralgia of TMJ and associated myalgia and sudden progressive symptomatology over last two to three months. (Oral & Maxillofacial Surgery)
Example 5
Initial office consultation for evaluation of a 70-year-old male with appetite loss and diminished energy. (Psychiatry)
Example 6
Initial office consultation for an elementary school-aged patient, referred by pediatrician, with multiple systematic complaints and recent onset of behavioral discontrol. (Psychiatry)
Example 7
Initial office consultation for a 23-year-old female with developmental facial skeletal anomaly and subsequent abnormal relationship of jaw(s) to cranial base. (Oral & Maxillofacial Surgery)
Example 8
Initial office consultation for a 45-year-old myopic patient with a one-week history of floaters and a partial retinal detachment. (Ophthalmology)
Example 9
Initial office consultation for a 65-year-old female with moderate dementia, mild unsteadiness, back pain fatigue on ambulation, intermittent urinary incontinence. (Neurosurgery)
Example 10
Initial office consultation for a 33-year-old female referred by endocrinologist with amenorrhea and galactorrhea, for evaluation of pituitary tumor. (Neurosurgery)
Example 11
Initial office consultation for a 34-year-old male with new onset nephritic syndrome. (Nephrology)
Example 12
Initial office consultation for a 39-year-old female with intractable chest wall pain secondary to metastatic breast cancer. (Anaesthesiology/Pain Medicine)
Example 13
Initial office consultation for a patient with multiple giant tumors of jaws. (Oral & Maxillofacial Surgery)
Example 14
Initial office consultation for a patient with a failed total hip replacement with loosening and pain upon walking. (Orthopaedic Surgery)
Example 15
Initial office consultation for a 60-year-old female with three-year history of intermittent tic-like unilateral facial pain; now constant pain for six weeks without relief by adequate carbamazepine dosage. (Neurosurgery)
Example 16
Initial office consultation for a 45-year-old male heavy construction worker with prior lumbar disk surgery two years earlier; now gradually recurring low back and unilateral leg pain for three months, unable to work for two weeks. (Neurosurgery)
Example 17
Initial office consultation of patient who presents with a 30-year history of smoking and right neck mass. (Otolaryngology/Head & Neck Surgery)
Example 18
Office consultation with 38-year-old female, with inflammatory bowel disease, who now presents with right lower quadrant pain and suspected intra-abdominal abscess. (General Surgery/Colon & Rectal Surgery)
Example 19
Office consultation with 72-year-old male with oesophageal carcinoma, symptoms of dysphagia and reflux. (Thoracic Surgery)
Example 20
Office consultation for disease of treatment options for a 40-year-old female with a 2cm adenocarcinoma of the breast. (Radiation Oncology)
Example 21
Office consultation for young patient referred by paediatrician because of patient short attention span, easy distractibility, and hyperactivity. (Psychiatry)
Example 22
Office consultation for 66-year-old female, history of colon resection for adenocarcinoma six year earlier, now with severe mid-back pain; X-ray showing osteoporosis and multiple vertebral compression fractures. (Neurosurgery)
Example 23
Office consultation for a patient with chronic pelvic inflammatory disease who now has left lower quadrant pain with a palpable pelvic mass. (Obstetrics & Gynaecology)
Example 24
Office consultation for a patient with long-sanding psoriasis with acute onset of erythroderma, pustular lesions, chills, and fever, Combinations of topical and systemic treatments discussed and instituted. (Dermatology)
