99252
Inpt/obs consult low MDM 35 min
Inpatient or observation consultation for a new or established patient, low-level medical decision making or 35 minutes total time. CMS 2026 wRVU 1.46. Used by consulting providers when a colleague requests evaluation and management input.
When to use it
Use 99252-99255 for inpatient or observation consultations when commercial payers accept consult codes. The consulting provider was specifically requested by another physician or QHP to provide an opinion or recommendation.
Full guidance
Medicare stopped recognizing inpatient consult codes (99252-99255) in 2010 and reinstated them in 2023 with new documentation requirements, but many Medicare hospitalists still default to 99221-99223 or 99231-99233 instead. Use 99252 for low-MDM consultations: stable problem, limited data, low risk.
Documentation checklist
- ✓Documentation of the requesting provider's name and specialty.
- ✓Reason for consultation (specific question or condition being evaluated).
- ✓Consultation note with assessment and recommendations communicated back to the requesting provider.
- ✓MDM low complexity OR 35 minutes total time.
Common pitfalls
- !Billing 99252 on a Medicare patient. Many Medicare contractors still do not separately recognize these codes; verify your contractor's policy. Most hospitalists default to 99231-99233 for Medicare consultations.
- !Missing the requesting-provider documentation. The chart must show who requested the consult and what question was asked.
Payer notes
Medicare reinstated 99252-99255 in 2023 but many Medicare contractors continue to instruct hospitalists to use initial-care or subsequent-care codes instead. Commercial payers including BCBS, Aetna, Cigna typically accept consult codes. Verify with each payer before defaulting to consult codes.