CPT Code 99244: Office or Other Outpatient Consultation

Learn the 99244 CPT code description, its documentation, and billing guidelines, and other similar evaluation and management codes.

Use Code

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.

Frequently asked questions

CPT code 99244 refers to an office or outpatient consultation for an established or new patient that requires moderate complexity medical decision making. It typically involves 40 minutes of face-to-face time with the patient and/or family.

CPT code 99245 is used for office or outpatient consultations requiring high-complexity medical decision-making. This service typically includes 55 minutes of face-to-face time with the patient and/or family.

CPT codes 99252 and 99253 fall under inpatient or observation consultations for new or established patients, but they differ in the complexity of their components and time spent. 99252 requires an expanded problem-focused history, an expanded problem-focused examination, and medical decision making of low complexity, typically involving 35 minutes of face-to-face time with the patient and/or family. In contrast, 99253 requires a detailed history, a detailed examination, and low complexity medical decision-making, typically requiring 45 minutes.