Hospital · CMS status A
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.
Work RVU
1.46
2026 Medicare pays
$72.15
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 1.46 + Practice 0.59 + Malpractice 0.11 = 2.16 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99252 is locked
- When to use it: the exact clinical situations that support billing 99252
- Documentation checklist: the 4 elements your note needs before submitting
- Common pitfalls: the 2 mistakes that get 99252 downcoded or denied
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Common ICD-10 pairings
I10E11.9N18.4
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.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.