99254 inpatient/obs cnsltj new/established mod 60
Also known as: hospital consultation moderate, complex inpatient consult, hospital specialist
Inpatient or observation hospital consultations for a new or established patient with moderate medical decision-making complexity and an expected time of 60 minutes.
In Plain Language
Detailed hospital consultation; Complex inpatient evaluation
Clinical Context
Used for hospital or observation consultations requiring moderate medical decision-making complexity, such as evaluation of multiple acute problems or complicated single conditions affecting hospitalized patients.
RVU Breakdown
| Work RVU | 2.72 |
| Total RVU | 2.72 |
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 2.72, this code ranks in the 80th percentile among Evaluation & Management codes — 1.8x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99254?
CPT 99254 (inpatient/obs cnsltj new/established mod 60) is a Evaluation & Management code. Inpatient or observation hospital consultations for a new or established patient with moderate medical decision-making complexity and an expected time of 60 minutes.
Who uses CPT code 99254?
CPT 99254 is used by Specialist Physicians, Hospital Medicine. Used for hospital or observation consultations requiring moderate medical decision-making complexity, such as evaluation of multiple acute problems or complicated single conditions affecting hospitalized patients.
When is CPT 99254 used?
Used for hospital or observation consultations requiring moderate medical decision-making complexity, such as evaluation of multiple acute problems or complicated single conditions affecting hospitalized patients.
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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.