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See a sample rate comparisonCPT 99253 Fee Schedule
Last Verified: October 2026
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.
Ip Obs Cnsltj New Est Low 45, Inpatient Or Observation 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 45 Minutes Must Be Met Or Exceeded
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Consultations |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 51 - Inpatient Psychiatric Facility |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99253 |
| Medicaid Fee Schedule | $84.53 median of the 7 states in the free preview · View Medicaid rates for 99253 |
National average reimbursement for CPT 99253 by major payers:
$63.04
$102.90
$142.61
$123.96
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CPT 99253
5 of 25 sample ratesHigher to lower in this preview
Sneha Badhey
Texas Health Physicians Group
$383.75Published rateJohn Higgins
U T Physicians
$161.58Published rateValerie Deluca
Robert Deluca Do PA
$133.14Published rateVivian Hoang
Comprehensive Neuro Monitoring LLC
$118.41Published rateStacey Rawls
New Directions Therapeutic Center
$85.26Published rate
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See a sample payer proposalCPT 99253 vs. Other Consultations Codes
The CPT 99253 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 99253 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 |
|---|---|---|
| 99252-CPT | Low | Ip Obs Consltj New Est Sf 35, Inpatient Or Observation 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 35 Minutes Must Be Met Or Exceeded |
| 99253-CPT | Low | Ip Obs Cnsltj New Est Low 45, Inpatient Or Observation 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 45 Minutes Must Be Met Or Exceeded |
| 99254-CPT | Moderate | Ip Obs Cnsltj New Est Mod 60, Inpatient Or Observation 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 60 Minutes Must Be Met Or Exceeded |
| 99255-CPT | High | Ip Obs Consltj New Est Hi 80, Inpatient Or Observation 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 80 Minutes Must Be Met Or Exceeded |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99253. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99253 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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Frequently Asked Questions
CPT 99253 is an Evaluation and Management (E/M) service code specifically for inpatient consultations, representing a moderate-complexity encounter. It is situated within a spectrum of consultation codes (e.g., 99251-99255 for inpatient consultations) that are differentiated primarily by the amount of provider time spent, the complexity of medical decision-making (MDM), and the level of documentation required. Compared to lower-level consultation codes (such as 99251 or 99252), CPT 99253 involves significantly more provider time and a greater level of medical decision-making. This typically includes managing multiple diagnoses, reviewing and interpreting complex diagnostic tests, or initiating medication management for conditions requiring moderate complexity. Lower-level codes are reserved for simpler, straightforward assessments with less time and fewer management decisions. Conversely, CPT 99253 is less complex than higher-level consultation codes (such as 99254 or 99255). These higher codes are utilized for more extensive encounters involving high-complexity medical decision-making, often for unstable patients, those with multiple severe comorbidities, or the management of life-threatening conditions requiring extensive data review and high-risk treatment options. Consequently, CPT 99253 generally leads to higher reimbursement than lower-level codes due to its increased complexity and time requirements, but less than the highest-level codes. It also necessitates more detailed documentation to support the moderate level of service provided.