99255
Ip/obs consltj new/est hi 80
Inpatient or observation consultation: high MDM or at least 80 minutes when selecting by time.
Published by RVUDoc. Numeric data: CMS RVU26D, effective 2026-10-01, checked 2026-10-03. Coding guidance reviewed 2026-09-23. Calculation limits and editorial policy.
No national non-facility estimate is shown for this status or setting. This does not determine other payer coverage.
Billing guidance for 99255 is locked
- When to use it: the exact clinical situations that support billing 99255
- Documentation checklist: the 2 elements your note needs before submitting
- Common pitfalls: the 2 mistakes that get 99255 downcoded or denied
Payer notes
Medicare does not pay consultation codes 99252-99255. Commercial recognition varies by plan.
Related codes
These include alternative services and possible add-ons. Listing codes together does not establish that they can be billed together; check the applicable edits and payer policy.
See what 99255 adds to your year
Add it to the wRVU calculator with your own volume, or paste a note and let the chart audit check your coding.