Is CPT 99241 still valid?

No. CPT deleted 99241 and 99251 effective January 1, 2023. Office and outpatient consultations now run 99242 through 99245, and inpatient consultations run 99252 through 99255. A straightforward office consultation is reported with 99242, since there is no longer a level 1 consultation code.

Does Medicare pay consultation codes?

No. Medicare stopped recognizing consultation codes in 2010. For Medicare patients, report the appropriate office or outpatient visit code, or the appropriate initial or subsequent hospital care code, instead. Many commercial payers still recognize consultations and often value them higher, so payer policy decides.

What must a consultation note document?

Three things: the request from another clinician for your opinion and the reason for it, the opinion or advice you rendered, and the written report back to the requesting clinician. A transfer of care is not a consultation.

Consultation Codes 99242 to 99245: Rules and Payers

In briefMedicare does not pay consultation codes; many commercial payers do, often at higher values, but policies vary by plan and should be verified.

A true consultation needs a request for opinion and a report back to the referring provider.
For referred commercial patients with no planned follow-up, the consultation often pays more.
Medicare wants new or established codes instead.

Medicare dropped them; commercial payers did not

Medicare eliminated payment for consultation codes effective January 1, 2010 and told physicians to substitute standard E/M codes. Most commercial payers still recognize and pay them, often above a new-patient visit. If you see referred patients, that split is real money, and a thoughtful consultation, reviewing the records, examining the patient fresh, and writing a real opinion back to a colleague, deserves the code that recognizes it.

Two practical notes on attribution

First, when a payer does not honor consultation codes and you report an office or hospital E/M instead, most employers still attribute the wRVUs of that service to you, so the level matters to your productivity numbers regardless of what the payer pays. Second, an eligible office E/M with a longitudinal patient can also carry G2211, about 0.33 wRVUs; consultations and one-time visits do not qualify, but an established relationship does.

The Three Requirements for a Consultation

For a payer that recognizes consultation codes, three elements must be present:

1. Request: another physician or qualified health professional asked for your opinion. Document the request: a referral note, an order, or a recorded phone or electronic message.

2. Rendering service: you performed and documented an evaluation that supports the level reported in the consultation range.

3. Report back: you sent your findings and recommendations to the requesting clinician as a written consultation note, letter, or documented message. This step cannot be skipped.

Missing any one of the three, the encounter is a standard new or established patient E/M. A transfer of care is not a consultation.

Medicare's Approach: Use Standard E/M Codes

For Medicare patients, report a new patient office visit (99202-99205) for a first encounter or an established patient visit (99212-99215) otherwise, leveled by MDM or time like any office visit.

Same level, new patient pays more, so whether a referred Medicare patient is new or established to your group is worth getting right; the three year rule that decides it, and the wRVU gap it protects, are in the MDM guide.

Quick answer version: Is CPT 99241 still a valid code?

The Outpatient Consultation Code Levels: 99242 to 99245

The 2023 revisions aligned outpatient consultation codes with the 2021 MDM-or-time framework and deleted 99241, paralleling the deletion of 99201:

CPT	MDM Level	Time Threshold
99242	Straightforward	20 min
99243	Low	30 min
99244	Moderate	40 min
99245	High	55 min

For commercial payers that recognize them, the moderate and high consultation levels pay at or above the equivalent new patient codes, so a specialist with heavy commercial referral volume should not default to new patient codes for everything.

Inpatient Consultations: 99252 to 99255

Inpatient consultation codes (99252-99255; 99251 was also deleted in 2023) follow the same request, render, report back rule for commercial payers. For Medicare inpatients, substitute initial hospital or observation care (99221-99223), leveled by MDM or time.

Practical check for specialists

If many of your patients are commercially insured referrals, verify that your coding team uses consultation codes where appropriate. The difference per visit is modest, but it adds up across a high-volume referral practice, and it ensures the referring physician receives the formal report the code implies.

Telehealth Consultations

Consultation codes apply to telehealth when the same three requirements are met and the evaluation supports the level. The modifier and place of service follow the same rules as any telehealth visit, covered in the telehealth guide; what is specific to consultations is coverage, so confirm the payer pays for telehealth consultations, since that varies by payer and state.

The Same Referral, Two Payers

A subspecialty wrinkle on "new" vs "established"

The three-year rule keys off same specialty and subspecialty, and Medicare distinguishes specialties by taxonomy. A patient seen by a general orthopaedic surgeon in your group, then referred to the group's sports-medicine orthopaedic surgeon, can sometimes be a new patient to the sports specialist if the taxonomies differ. Confirm how your group's providers are enrolled before relying on it; it is a legitimate distinction, not a loophole.

A cardiologist sees a patient referred by their primary care physician for palpitations, with a clear request for opinion and a report back. A commercial payer that recognizes consultation codes gets an office consultation. Medicare gets a standard new or established office visit for the identical encounter. Same work, same documentation, different code by payer, so know which of your payers accept consults and code each accordingly rather than defaulting to one habit for everyone.

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