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.
In Plain Language
Comprehensive specialist consultation; Complex medical evaluation
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 |
| Total RVU | 3.75 |
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 3.75, this code ranks in the 89th percentile among Evaluation & Management codes — 2.4x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99245?
CPT 99245 (Off/outpatient consltj new/established hi 55) is a Evaluation & Management code. Office or other outpatient consultations for a new or established patient with high medical decision-making complexity and an expected time of 55 minutes.
Who uses CPT code 99245?
CPT 99245 is used by Specialist Physicians, All Specialties. 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.
When is CPT 99245 used?
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.
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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.