CPT 99245 Fee Schedule
Healthcare providers use this code to document and receive reimbursement for visits that address high-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 | High |
National average reimbursement for CPT 99245 by major payers:
$103.20
$238.97
$250.03
$254.27
| 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 99245 | ||||||
United | 99245 | $216.72 | 1477139541 - JATIN SADARANGANI | 922465140 | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $157.35 | 1578532370 - PETER ALPERIN | 550853118 - CENTRAL TEXAS COMMUNITY HEALTH CENTERS | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $206.89 | 1366929457 - THAMER ALMALKI | 822363882 - (TX) LA MAGNA HEALTH, PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $203.00 | 1467534008 - RUBEN DE LOS SANTOS | 742548071 - RUBEN DE LOS SANTOS, MD, PA | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $221.11 | 1861479222 - DAVID CHEATHAM | 752355112 | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $260.41 | 1629050521 - GARY GOFF | 814211188 - (TX) TEXIENNE PHYSICIANS MEDICAL ASSOCIATION PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $379.32 | 1598393514 - SPENCER GUNNELL | 742958277 - SCOTT & WHITE CLINIC | TX | Neurology Physician (2084N0400X) |
United | 99245 | $277.07 | 1063868677 - YU-HSUAN LIAO | 270381199 | TX | Neurology Physician (2084N0400X) |
United | 99245 | $229.82 | 1528744935 - CLOUD HEALTH MEDICAL GROUP, P.A. | 932013924 - (CA) CLOUD HEALTH MEDICAL GROUP PA | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $249.08 | 1073558433 - RINA SARKAR | 823049606 - (TX) SARKAR MORE HEALTH PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $302.26 | 1386632776 - LUIS SABATINI | 860828589 | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $238.83 | 1114053550 - TIYONNOH CASH | 352526373 - ACCLAIM PHYSICIAN GROUP INC | TX | Neurology Physician (2084N0400X) |
United | 99245 | $191.39 | 1174188858 - MOHAMMED KARIMJEE | 272273286 - (TX) NAJMUDDIN KARIMJEE, MD | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $199.66 | 1699867044 - SAMIRAN DAS | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | TX | Internal Medicine Physician (207R00000X) |
United | 99245 | $449.88 | 1699156273 - ELLIANA WIESNER | 741895118 - (TX) FREDERICKSBURG CLINIC, P.A. | 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 99245 vs. Other Consultations Codes
The CPT 99245 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 99245 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 99245. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99245 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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