CPT Code 99244: Office or Other Outpatient Consultation

What is an office or other outpatient consultation (CPT 99244)?

CPT code 99244 is for an office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. The provider usually weighs in on a specific issue, like when a primary doctor refers a patient to a specialist.

The code can be used whether the patient is new to the provider or someone they’ve seen before. The visit must show that the provider made some decisions based on tests, symptoms, or treatment options. Another way to qualify for 99244 is if the total time spent on the day of the visit is at least 40 up to 54 minutes. It’s a good fit for consults with moderate to high severity. This code is for visits that take some time and require careful consideration, but don’t involve high-risk decisions.

When managing a patient's care or a specific condition, home or residence services, along with office or outpatient visits, are reported using the appropriate new or established patient codes.

CPT code 99244 documentation requirements

To bill CPT 99244 correctly, documentation should include the following:

• Reason for consultation, including who requested it and why  
• Comprehensive history relevant to the patient’s condition  
• Comprehensive examination appropriate to the presenting problem  
• Medical decision-making of moderate complexity  
• Counseling or coordination of care with other qualified health care professionals
• Clear assessment and plan outlining next steps

This documentation supports the requirements for CPT 99244 and helps ensure accurate billing.

CPT code 99244 billing guidelines

Here are some important billing considerations for CPT code 99244:

• Consultation codes, including 99244, require a formal request from another healthcare provider.
• CPT 99244 is suitable for moderate to high complexity; less complex consultations should utilize lower-level codes.
• CPT 99244 may be used to report consultations provided in the office or other outpatient sites, including the home, residence, or emergency department.
• If billing is based on time, document the time spent on the encounter date. This must be between 40 and 54 minutes and can include face-to-face time and time spent reviewing records, completing documentation, and coordinating care.
• Document clearly that consultation findings were reported back to the requesting physician.
• Check with the payer before billing consultation codes.

Other CPT codes for office or other outpatient consultations

• 99242: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making (20 minutes).
• 99243: Office or other outpatient consultation for a new or established patient, requiring a medically appropriate history and/or examination and low medical decision making (30 minutes).
• 99245: Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and high level of medical decision making (55 minutes).

Prolonged services codes are used if the time spent on a patient's care exceeds the typical duration for a specific E/M service, typically due to additional activities.