Hospital · CMS status A
99253
Inpt/obs consult mod MDM 45 min
Inpatient or observation consultation, moderate-level medical decision making or 45 minutes total time. CMS 2026 wRVU 2.19.
Work RVU
2.19
2026 Medicare pays
$108.22
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 2.19 + Practice 0.88 + Malpractice 0.17 = 3.24 total
Work (your effort)Practice expenseMalpractice
When to use it
Most common inpatient consultation level for commercial payers. Use for moderate-MDM consultations: two or more chronic problems addressed, prescription drug management, one undiagnosed problem with uncertain prognosis.
Full guidance
Real examples: cardiology consult for new AFib with anticoagulation decision, ID consult for fever workup with empiric antibiotic recommendation.
Documentation checklist
- ✓All 99252 requirements (requesting provider, reason, communicated assessment).
- ✓MDM moderate complexity OR 45 minutes total time.
- ✓Prescription drug recommendation or moderate-data review supports moderate MDM.
Common pitfalls
- !Same Medicare-recognition pitfall as 99252. Verify payer policy.
- !Down-coding to 99252 when prescription drug management or moderate-data elements are documented.
Common ICD-10 pairings
I48.91J18.9K72.10
Payer notes
Most common commercial-payer inpatient consult code. Documentation should support the MDM level explicitly.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.