Summary & Overview
CPT 99244: Office or Outpatient Consultation, Moderate Complexity
CPT code 99244 represents a moderate complexity office or outpatient consultation for new or established patients, requiring a medically appropriate history and/or examination and moderate level of medical decision making, or at least 40 minutes of total time spent on the date of the encounter. This code is widely used across the United States in ambulatory care settings, including primary care, internal medicine, pediatrics, and obstetrics & gynecology.
Major national payers such as Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare recognize and reimburse for services billed under CPT code 99244. The code is central to evaluation and management billing, reflecting the clinical complexity and time required for patient consultations.
Readers will gain insight into the clinical context of CPT code 99244, including its definition, typical site of service, and its role in outpatient care. The publication also covers payer coverage, common modifiers, associated provider taxonomies, relevant ICD-10 diagnoses, and related CPT codes. Policy updates and benchmarks are discussed to provide a comprehensive overview of how this code is utilized in medical billing and reimbursement.
CPT Code Overview
CPT code 99244 is used for office or other outpatient consultations for new or established patients. This code applies when a medically appropriate history and/or examination is performed, and the encounter involves a moderate level of medical decision making. Alternatively, when selecting the code based on total time, the visit must meet or exceed 40 minutes on the date of the encounter.
Service Type: Evaluation and Management – Office or Other Outpatient Consultation
Typical Site of Service: Office or outpatient setting, such as Office (POS 11).
Clinical & Coding Specifications
Clinical Context
A patient is referred to an office or outpatient setting for a consultation regarding a new or ongoing health concern. The provider, such as an internal medicine physician, family medicine physician, pediatrician, general practice physician, or obstetrics & gynecology physician, conducts a medically appropriate history and/or examination. The clinical workflow involves moderate complexity medical decision making, which may include reviewing prior records, ordering diagnostic tests, and discussing management options. The encounter requires at least 40 minutes of total time on the date of service if time is used for code selection. Common scenarios include evaluation for headaches, abdominal pain, fatigue, or routine medical or gynecological examinations without abnormal findings.
Coding Specifications
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Modifiers:
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Modifier
25: Significant, Separately Identifiable Evaluation and Management Service by the Same Physician on the Same Day of the Procedure or Other Service. Used when an E/M service is provided in addition to another procedure or service on the same day. -
Modifier
95: Synchronous Telemedicine Service Rendered via a Real-Time Interactive Audio and Video Telecommunications System. Used when the consultation is performed via telemedicine.
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Provider Taxonomies: