2025 CPT code 99252
Effective Date: N/A Revision Date: N/A Evaluation and Management - Consultations Feed
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.
Medical necessity for consultation services must be supported by documentation demonstrating the need for specialized knowledge or expertise beyond the scope of the requesting provider.
The consulting physician is responsible for reviewing the patient's history, performing a medically appropriate exam if necessary, assessing the problem, and providing recommendations to the requesting physician. The consultant must communicate their findings and recommendations in a written report back to the requesting physician.
In simple words: A doctor was asked by another healthcare provider to give their expert opinion about a patient's condition while the patient is in the hospital or under observation. This visit involved simpler medical decisions, or the doctor spent at least 35 minutes in total providing this service.
This code represents an evaluation and management (E/M) service provided at the request of another physician or qualified healthcare professional for a patient in an inpatient or observation setting. The consultation involves a straightforward level of medical decision making (MDM), or the provider spends at least 35 minutes of total time on the date of the encounter. Total time includes all activities performed by the provider on the encounter date, both face-to-face and non-face-to-face, related to the consultation. The provider determines the extent of history and/or physical exam that is medically appropriate for the encounter, and these components do not factor into code selection.
Example 1: A hospitalized patient with a newly diagnosed heart condition is seen by a cardiology consultant at the request of the admitting physician., A patient in observation status for abdominal pain is seen by a gastroenterology consultant at the request of the attending physician., A hospitalized patient with uncontrolled diabetes is seen by an endocrinology consultant at the request of the hospitalist.
Documentation should include the request for consultation, the consultant's report detailing their opinion and recommendations, and any services ordered or performed. Time spent on the encounter can be documented if using that method for code selection.
** Medicare does not recognize consultation codes. For Medicare patients, other E/M codes should be used, such as initial hospital care or subsequent hospital care, depending on the circumstances.
- Place of Service:Inpatient Hospital, On Campus-Outpatient Hospital