Hospital · CMS status A
99254
Inpt/obs consult mod-high MDM 60 min
Inpatient or observation consultation, moderate-to-high level medical decision making or 60 minutes total time. CMS 2026 wRVU 3.06.
Work RVU
3.06
2026 Medicare pays
$151.31
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 3.06 + Practice 1.24 + Malpractice 0.23 = 4.53 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99254 is locked
- When to use it: the exact clinical situations that support billing 99254
- Documentation checklist: the 3 elements your note needs before submitting
- Common pitfalls: the 2 mistakes that get 99254 downcoded or denied
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Common ICD-10 pairings
A41.9J96.01I50.32N17.9
Payer notes
Audit risk for elevated 99254 rates among consulting specialists. Documentation supporting the level is critical.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.