CPT 99243 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Evaluation and Management • Consultations |
| Common Place of Service | • 11 - Office • 22 - On Campus Outpatient Hospital • 19 - Off Campus Outpatient Hospital |
| Common Modifiers | • None • 25 - Significant, separately identifiable E/M service same day • 95 - Telemedicine - audio and video |
| Complexity Level | Moderate |
National average reimbursement for CPT 99243 by major payers:
$55.25
$133.20
$139.97
$136.45
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99243 | ||||||
United | 99243 | $142.05 | 1770732398 - DAVID RUIZ-BELLO | 752966610 - (TX) PHYSICIAN ASSOCIATES OF SOUTHWEST DALLAS | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $100.76 | 1982825683 - LEWISVILLE NEUROLOGY P.A. | 752608707 - LEWISVILLE NEUROLOGY, P.A. | TX | Neurology Physician (2084N0400X) |
United | 99243 | $173.17 | 1538796172 - TAYLER ACTON | 742958277 - SCOTT & WHITE CLINIC | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $102.51 | 1477548071 - ARSHAD UMER | 830348859 | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $284.20 | 1205922481 - BRET MCADEN | 760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $151.89 | 1255384574 - WILLIAM FLEMING | 741824287 - (TX) MEMORIAL NEUROLOGICAL ASSOCIATION | TX | Neurology Physician (2084N0400X) |
United | 99243 | $238.85 | 1235490426 - TIGIST MEHARI | 61562701 - (NY) ST CATHERINE OF SIENA MEDICAL CENTER | TX | Neurology Physician (2084N0400X) |
United | 99243 | $132.25 | 1932307766 - TRUNG NGUYEN | 844480979 - (TX) LONGVIEW INTERNAL MEDICINE PHYSICIANS, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $250.38 | 1174635452 - LILLIAN WHITE | 752926231 - (TX) LILLIAN R WHITE MD PA | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $88.98 | 1306987474 - MUSTAFA MOAZAM | 274687405 - (CO) MOAZAM PA | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $161.33 | 1184656555 - STEPHEN RYDZAK | 823426999 | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $167.69 | 1285255877 - JOHN MARTINO | 752931720 | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $240.55 | 1881853281 - VISHAL PATEL | 752536818 - HEALTHTEXAS PROVIDER NETWORK | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $136.00 | 1326069139 - XIAO LI | 760221050 | TX | Internal Medicine Physician (207R00000X) |
United | 99243 | $101.83 | 1053373951 - REGIONAL EMPLOYEE ASSISTANCE PROGRAM INC | 760423386 - REGIONAL EMPLOYEE ASSISTANCE PROGRA M | TX | Internal Medicine Physician (207R00000X) |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
United | 99202 | $100.00 | 1234567890 | 1234567890 | CA | Cardiologist |
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CPT 99243 vs. Other Consultations Codes
The CPT 99243 code is part of the Evaluation and Management services used for Consultations. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99243 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99242 | Low | Office Or Other Outpatient Consultation For A New Or Established Patient Which Requires A Medically Appropriate History And/Or Examination And Straightforward Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 20 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99243 | Low | Office Or Other Outpatient Consultation For A New Or Established Patient Which Requires A Medically Appropriate History And/Or Examination And Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 30 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99244 | Moderate | Office Or Other Outpatient Consultation For A New Or Established Patient Which Requires A Medically Appropriate History And/Or Examination And Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
| 99245 | High | Office Or Other Outpatient Consultation For A New Or Established Patient Which Requires A Medically Appropriate History And/Or Examination And High Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 55 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99243. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99243 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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