CPT Code 99245: Office or Outpatient Consultation, High Complexity

The 99245 CPT code is used for a high-level, new patient consultation involving a detailed history, detailed exam, and high-complexity medical decision-making by a qualified health care professional. It's basically for when a specialist is brought in, and the case is pretty complicated.

The difference between these office and outpatient services is in the complexity. 99244 is for moderate-complexity cases, while 99245 is for high-complexity ones that usually need more time and judgment. Select 99245 if the patient’s situation is more serious and needs more in-depth consultation services.

Medicare no longer covers the CPT consultation codes, including 99245, and instead wants you to use evaluation and management (E&M) codes based on where the visit happens and how complex it is.