Summary & Overview
CPT 99452: Interprofessional Electronic Consultation, 30 Minutes
CPT code 99452 captures a provider’s non-face-to-face, interprofessional communication when a treating or requesting physician or other qualified healthcare professional spends 30 minutes providing patient-related healthcare information to a consultant via electronic media. This service code matters nationally as health systems increasingly rely on electronic consultations and remote coordination to improve access, reduce unnecessary visits, and document clinician-to-clinician advice.
Key payers covered in this publication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of how 99452 is defined, the clinical contexts where interprofessional electronic consults are used, and the policy and billing considerations that influence adoption across payers. The report summarizes typical sites of service and service type, explains what time-based documentation elements are required, and highlights common modifier usage patterns when data are available.
The publication also provides benchmarks and implementation guidance for coding and documentation workflows, plus summaries of recent policy updates affecting interprofessional electronic communications. Data not available in the input are noted explicitly where applicable.
Billing Code Overview
CPT code 99452 describes a treating or requesting physician or other qualified healthcare professional spending 30 minutes providing healthcare information about a patient to a consultant via electronic media. This represents a consultant-directed interprofessional communication service delivered remotely.
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Service type: Interprofessional consultative communication (telephone, secure text, electronic health record message, or other electronic media) lasting 30 minutes of the provider's time.
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Typical site of service: Remote or non-face-to-face clinician setting; services are provided outside of direct patient encounters and can be delivered from an office, clinic, or other location where the consulting provider documents and transmits information electronically.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A primary care physician or treating specialist spends 30 minutes communicating detailed patient information to a consulting clinician using phone, secure text, secure email, or other electronic media. Typical scenario: a 68-year-old patient with congestive heart failure (CHF) and worsening dyspnea is evaluated in primary care; the treating physician reviews recent vitals, medication list, recent BNP, chest x-ray report, and clinical status, then discusses the case with a cardiologist by secure telephone to determine whether urgent cardiology input or outpatient follow-up is needed. The treating physician documents the 30-minute consultative exchange in the medical record, including data reviewed, recommendations communicated, and plan for follow-up. Typical workflow includes chart review, synthesizing clinical information, initiating and conducting the electronic consultation, and documenting time and content in the medical record prior to billing. Typical site of service is an outpatient office, clinic, or other non-facility setting where the treating clinician has access to the patient’s record; electronic communication can occur across settings (clinic to consultant office, clinic to hospital-based consultant) using phone, secure messaging, or telehealth platforms.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 | Significant, separately identifiable E/M service by the same physician on the same day | Use when a distinct face-to-face E/M visit is provided the same day as the electronic consultation and both are documented separately. |
52 | Reduced services | Use when the electronic consultation service is partially reduced or truncated and not performed as described for full code. |
53 | Discontinued procedure | Use if the electronic consultation process was started but discontinued due to patient condition or other factors. |
62 | Two surgeons | Use when two surgeons from different specialties jointly participate in the consultation process and billing rules permit shared reporting. |
78 | Unplanned return to operating room | Rarely applicable; use if the electronic consultation directly results in an unplanned operative procedure during the same encounter when reporting requires the modifier. |
80 | Assistant surgeon | Use when a qualified assistant participates in management and reporting in accordance with payer rules. |
95 | Synchronous telemedicine service rendered via real-time interactive audio and video | Use when the 30-minute consultation occurs via real-time interactive audio/video platform and payer requires telehealth modifier for interactive services. |
GT | Via interactive audio and video telecommunication systems | Use when the consultation is furnished through interactive telecommunication systems and the payer recognizes GT for telehealth services. |
GQ | Via asynchronous telecommunications system (store-and-forward) | Use when the consultation is provided using asynchronous communications (store-and-forward) and payer supports GQ. |
93 | Synchronous telemedicine service rendered via telephone or other real-time audio-only communication | Use when the 30-minute consult is performed by real-time audio-only and payer recognizes 93. |
25 | (Included above) | (Duplicate entry removed in table) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
| 207R00000X | Family Medicine | Primary care clinicians frequently provide and document electronic consultations to specialists. |
| 208D00000X | General Practice | Office-based general practitioners initiate and coordinate consults via electronic media. |
| 207L00000X | Internal Medicine | Hospitalists and internists often perform these interprofessional electronic communications for complex chronic disease. |
| 207RC0000X | Emergency Medicine | Emergency physicians may provide or request brief electronic consultations for disposition decisions. |
| 2084P0800X | Cardiology | Cardiologists commonly receive electronic consults for heart failure, arrhythmia, or ischemic concerns. |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
I50.9 | Heart failure, unspecified | Common reason for primary-care to seek cardiology input about management changes, medication adjustments, or need for urgent evaluation. |
J18.9 | Pneumonia, unspecified organism | Respiratory infection with comorbidity may prompt interprofessional discussion about disposition and antibiotic choices. |
R06.02 | Shortness of breath | Symptom prompting review of diagnostics and specialist input via electronic consultation. |
I48.91 | Unspecified atrial fibrillation | Common cardiovascular diagnosis that often warrants specialist input for anticoagulation or rate/rhythm management. |
E11.9 | Type 2 diabetes mellitus without complications | Common comorbidity reviewed during interprofessional exchanges affecting medication choices and care coordination. |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
99446 | Interprofessional telephone/Internet assessment and management service provided by a consulting physician, 5-10 minutes of medical consultative discussion and review | Used for shorter interprofessional consults; 99452 covers the treating physician’s time whereas 99446 is the consultant’s equivalent for brief consults. |
99451 | Interprofessional telephone/Internet assessment and management service provided by a consultative physician, 5 minutes or more of medical consultative time | Related consultant-side reporting when the consultant documents review and recommendations; complements the treating clinician’s 99452 report. |
99457 | Remote evaluation of recorded video and/or images submitted by an established patient, including interpretation and report, 20 minutes or more | May occur in workflows involving asynchronous review of patient-generated data alongside the interprofessional exchange. |
99421 | Online digital evaluation and management service, for an established patient, 5-10 minutes | May be used for patient-to-practitioner secure messaging that supplements the interprofessional communication. |
99453 | Remote monitoring setup and patient education on use of equipment | Often performed before telemonitoring data are reviewed and discussed during an interprofessional consult such as 99452. |