99255 inpatient/obs consltj new/established hi 80
Also known as: complex hospital consultation, high complexity consult, comprehensive hospital consult
Inpatient or observation hospital consultations for a new or established patient with high medical decision-making complexity and an expected time of 80 minutes.
In Plain Language
Complex hospital specialist evaluation; Comprehensive inpatient consultation
Clinical Context
Used for hospital or observation consultations with high medical decision-making complexity, requiring comprehensive evaluation and recommendations for complex, multi-system acute problems in hospitalized patients.
RVU Breakdown
| Work RVU | 3.86 |
| Total RVU | 3.86 |
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 3.86, this code ranks in the 92nd percentile among Evaluation & Management codes — 2.5x the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99255?
CPT 99255 (inpatient/obs consltj new/established hi 80) is a Evaluation & Management code. Inpatient or observation hospital consultations for a new or established patient with high medical decision-making complexity and an expected time of 80 minutes.
Who uses CPT code 99255?
CPT 99255 is used by Specialist Physicians, Hospital Medicine, Critical Care. Used for hospital or observation consultations with high medical decision-making complexity, requiring comprehensive evaluation and recommendations for complex, multi-system acute problems in hospitalized patients.
When is CPT 99255 used?
Used for hospital or observation consultations with high medical decision-making complexity, requiring comprehensive evaluation and recommendations for complex, multi-system acute problems in 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.