CPT Code Lookup Tool
Use this free CPT Lookup Tool to search for Current Procedural Terminology (CPT) codes, descriptions, and related details — designed to help streamline and simplify your medical billing process.
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Office or other outpatient visit
Evaluation and management of an established patient...
Information
This code is for use in medical billing and coding.
Information
This code is part of the section of CPT codes.
Office or other outpatient visit for the evaluation and management...
Note
This description reflects the 2021 E/M coding guidelines.
Information
codes are used to report evaluation and management services provided in various settings.
Information
RVUs are used to determine the fee for a service under the Medicare Physician Fee Schedule.
Information
This code is commonly used by primary care providers, but may be used by any specialty providing office visits.
Significant, separately identifiable E/M service
Information
Modifiers provide additional information about the service provided.
Detail About CPT 99254
Related Codes Table
| Code | Description |
|---|---|
| 99251 | Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. |
| 99252 | Inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of moderate complexity. |
| 99253 | Inpatient consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. |
| 99255 | Inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. |
Commonly Billed With
CPT code 99254 is commonly billed with CPT codes 36415 (Routine venipuncture) and 96372 (Therapeutic, prophylactic, or diagnostic injection).
Clinical Scenarios
Scenario 1:
A physician is asked by another physician to provide an inpatient consultation on a patient with complex medical issues. The physician reviews the patient's medical records, performs a comprehensive examination, and provides recommendations to the requesting physician.
Scenario 2:
An oncologist requests an inpatient consultation for a newly admitted cancer patient. The consulting physician conducts a detailed review of the patient's medical history and current condition, performs a detailed examination, and formulates a treatment plan.
FAQ
Q: What are the key components required for CPT code 99254?
A: CPT code 99254 requires a comprehensive history, a comprehensive examination, and medical decision making of moderate complexity.
Q: Can CPT code 99254 be used for both new and established patients?
A: Yes, CPT code 99254 can be used for both new patients and established patients.
Q: Is CPT code 99254 specific to inpatient consultations only?
A: Yes, CPT code 99254 is specifically for inpatient consultations.
Q: Are there any age restrictions for billing CPT code 99254?
A: There are no age restrictions associated with billing CPT code 99254.
Q: How does the complexity of medical decision making affect the choice of CPT level?
A: The complexity of medical decision making plays a significant role in determining the appropriate level of CPT code to use. For code 99254, it should involve medical decision making of moderate complexity.
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