CPT^® 99245, Under New or Established Patient

The Current Procedural Terminology (CPT^®) code 99245 as maintained by American Medical Association, is a medical procedural code under the range - New or Established Patient.

Additional/Related Information

Tabs

Summary

The provider sees a patient for an office or other outpatient consultation involving evaluation and management (E/M). The E/M involves a high level of medical decision making or the provider spends at least 55 minutes of total time on the encounter on a single date.

For clinical responsibility, terminology, tips and additional info
start codify free trial.

View any code changes for 2024 as well as historical information on code creation and revision.

Crosswalks

Tabs

Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT® code.

View the CPT® code's corresponding procedural code and DRG. In a click, check the DRG's IPPS allowable, length of stay, and more. To plug inpatient facility revenue drains, subscribe to DRG Coder today.

Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! Subscribe to Anesthesia Coder today.

View matching HCPCS Level II codes and their definitions.

Forum

Have a question about CPT Code 99245 ? Start a discussion here

lactation consultation

hello all, i do have a question regarding coding and billing for lactation consultation BY CLC ( certified lactation consultation) . how do we bill that. i did few research and found that we can bill... [ Read More ]

Modifier 25 with 99223 and 99497

Based on NCCI guidelines, modifier 25 would be appended to CPT 99497 when reported with 99223 when appropriate. For this NCCI edit pair, CPT 99223 is the column 1 code and 99497 is the column 2 code.... [ Read More ]

observation consult by specialist

For payers that accept consultation codes, you would use 99241-99245. For Medicare and other payers or plans that no longer accept consultation codes, you would use 99201-99215 for a consultation whi... [ Read More ]

AETNA CONSULTS

[QUOTE="tscobee, post: 502841, member: 9946"] We are having trouble getting paid for initial date seen in the hospital by Aetna. They are saying the plan has a maximum number of services allowed for t... [ Read More ]

E/M Consultation - CPC exam prep question - help

[QUOTE="carrie.townsend@modahealth.com, post: 504265, member: 732844"] I am sitting for my CPC exam on Saturday. There is a question in the Study Guide that has me stumped (and my two CPC colleagues ... [ Read More ]

E/M Consultation - CPC exam prep question - help 99242 99244 consultation e/m

I am sitting for my CPC exam on Saturday. There is a question in the Study Guide that has me stumped (and my two CPC colleagues too). A 55-year-old patient is seen in an office visit by an otolaryng... [ Read More ]

AETNA CONSULTS

We are having trouble getting paid for initial date seen in the hospital by Aetna. They are saying the plan has a maximum number of services allowed for this procedure even though this is the first an... [ Read More ]

Consultations, payers and new guidelines

[QUOTE="Patricia P Williams, post: 502001, member: 11276"] Anyone else who still uses Consultation Codes (99241-99245) seeing denials for these now from Anthem and Anthem Healthkeepers? Beginning with... [ Read More ]

Consultations, payers and new guidelines

Anyone else who still uses Consultation Codes (99241-99245) seeing denials for these now from Anthem and Anthem Healthkeepers? Beginning with Date of service 10/01/2021, all of ours are being denied n... [ Read More ]

AETNA DENIALS MAINLY WITH W BEGINNING OF ID#

My guess is that they still use Consultation codes 99241-99245 99251-99255. There aren't many payers out there that do, but the fact that they are saying they only allow one "initial" visit per day l... [ Read More ]

View All