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
When to use it
Used for inpatient consultations involving complex decision-making short of high-acuity life-threat.
Full guidance
Real examples: nephrology consult for AKI with dialysis decision-pending, pulmonology consult for hypoxic respiratory failure with ventilator decision, cardiology consult for cardiogenic shock with mechanical circulatory support discussion.
Documentation checklist
- ✓All 99252 requirements.
- ✓MDM moderate-to-high complexity OR 60 minutes total time.
- ✓Documentation of multi-source data review or significant decision-making complexity.
Common pitfalls
- !Up-coding from 99253 without supporting documentation of the higher-complexity element.
- !Same Medicare-recognition issue as the lower-level consult codes.
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.