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CPT 99244: Office/Outpatient Consultation, Moderate Complexity
CPT code 99244 designates an office or other outpatient consultation involving evaluation and management at a moderate level of medical decision making or when the provider documents at least 40 minutes of total time on the encounter. Nationally, this code is used to bill for higher-complexity outpatient consults that require extended evaluation or prolonged provider time, and it sits between lower- and higher-level consultation codes in the E/M spectrum. Key payers included in this review are Aetna, Blue Cross Blue Shield, Cigna Health, United Healthcare, and Medicare.
Readers will find a concise overview of clinical context for 99244, how it relates to adjacent consultation codes, and typical sites of service for billing. The publication summarizes payer coverage patterns and common administrative considerations for outpatient consultations billed at this level, and it highlights where 99244 fits within E/M coding choices. It also outlines relevant benchmarking and policy updates that affect national use and reimbursement dynamics for moderate-complexity consults. Data not available in the input is noted where applicable.
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Billing Code Overview
CPT code 99244 represents an office or other outpatient consultation for a new or established patient involving evaluation and management. The visit reflects a moderate level of medical decision making or at least 40 minutes of total time spent by the provider on a single date of service.
Service type: Evaluation and Management (Consultation)
Typical site of service: Office or other outpatient setting
National Reimbursement Benchmarks
Across national commercial payers, average commercial (BUCA) sits at $200.30, positioning it near the center of the payer mix. UnitedHealth Group posts the highest central tendency with a median of $230.90 and a mean of $256.00, while Blue Cross Blue Shield’s mean is $194.00 and Cigna’s mean is $207.80. Aetna’s mean is lower at $162.30. Maximum rates vary notably, with UnitedHealth Group reaching $562.70 and Cigna $477.20, highlighting potential outliers at the top end.
Dispersion (P75 minus P25) is tightest for Blue Cross Blue Shield at $61.30 (P75 $217.90 minus P25 $156.60), suggesting more consistent contracted rates, while Cigna shows the widest interquartile spread at $116.70 (P75 $261.50 minus P25 $144.80). UnitedHealth Group also exhibits substantial dispersion of $141.00 (P75 $315.60 minus P25 $174.60), indicating greater variability in mid-range commercial payments.