Hospital · CMS status A
99255
Inpt/obs consult high MDM 80 min
Inpatient or observation consultation, high-level medical decision making or 80 minutes total time. CMS 2026 wRVU 3.64.
Work RVU
3.64
2026 Medicare pays
$180.03
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 3.64 + Practice 1.47 + Malpractice 0.28 = 5.39 total
Work (your effort)Practice expenseMalpractice
When to use it
Reserved for high-complexity inpatient consultations:
Full guidance
imminent organ failure, decision regarding ICU transfer, drug therapy requiring intensive monitoring, or decision to de-escalate care. Real examples: oncology consult for newly diagnosed metastatic disease with treatment decision; palliative care consult for end-of-life transition; transplant evaluation consult.
Documentation checklist
- ✓All 99252 requirements.
- ✓MDM high complexity OR 80 minutes total time.
- ✓Explicit high-risk element documented.
Common pitfalls
- !Up-coding from 99254 without a documented high-risk element.
- !Time-based 99255 with vague time documentation.
Common ICD-10 pairings
C78.9I50.21A41.9K72.10
Payer notes
Highest-paying consultation code; audit-prone. Documentation must explicitly support high-MDM.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.