99255
HospitalCMS status: AInpatient or observation consultation, high-level medical decision making or 80 minutes total time. CMS 2026 wRVU 3.64.
Work RVU
3.64
Practice RVU
1.47
Malpractice RVU
0.28
Total RVU
5.39
2026 Medicare payment
$180.03
National GPCI = 1.000 · Conversion factor $33.4009 · Non-facility
Model this code
Drop 99255 into a scenario to see how unit volume rolls up to annual wRVUs, gross collections, and bonus.
Open in calculator →When to use it
Reserved for high-complexity inpatient consultations: 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.