99242 Off/outpatient consltj new/established sf 20
Also known as: office consultation, specialist consult, brief consultation, office consult level 2
Office or other outpatient consultations for a new or established patient with straightforward medical decision-making complexity and an expected time of 20 minutes.
In Plain Language
Doctor referral appointment; Specialist opinion visit
Clinical Context
Used for office-based consultation by a physician who is requested to evaluate and provide recommendations on specific problems or conditions for new or established patients with straightforward complexity.
RVU Breakdown
| Work RVU | 1.08 |
| Total RVU | 1.08 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 1.08, this code ranks in the 31st percentile among Evaluation & Management codes — 1.4x below the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99242?
CPT 99242 (Off/outpatient consltj new/established sf 20) is a Evaluation & Management code. Office or other outpatient consultations for a new or established patient with straightforward medical decision-making complexity and an expected time of 20 minutes.
Who uses CPT code 99242?
CPT 99242 is used by Specialist Physicians, All Specialties. Used for office-based consultation by a physician who is requested to evaluate and provide recommendations on specific problems or conditions for new or established patients with straightforward complexity.
When is CPT 99242 used?
Used for office-based consultation by a physician who is requested to evaluate and provide recommendations on specific problems or conditions for new or established patients with straightforward complexity.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.