99245 Off/outpatient consltj new/established hi 55
Also known as: complex consultation, high complexity consult, comprehensive specialist visit, office consult level 5
Office or other outpatient consultations for a new or established patient with high medical decision-making complexity and an expected time of 55 minutes.
Clinical Context
Used for office-based consultations with high medical decision-making complexity, such as evaluation of complex, multi-system problems requiring comprehensive diagnostic and therapeutic planning from a specialist.
RVU Breakdown
| Work RVU | 3.75 |
| Practice Expense RVU | 2.30 |
| Malpractice RVU | 0.22 |
| Total RVU | 6.27 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Specialties
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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.