Which consultation code is straightforward MDM?

99242 for an office or outpatient consultation and 99252 for an inpatient or observation consultation.

Does Medicare pay consultation codes?

No. Medicare stopped recognizing consultation codes in 2010. 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 than the equivalent visit.

Is CPT 99241 Still a Valid Code?

Q: Is CPT 99241 still a valid code?

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 consultation with straightforward medical decision making is reported with 99242, since there is no longer a level 1 consultation code.

Direct answer

No. CPT deleted 99241 and 99251 effective January 1, 2023. Office and outpatient consultations now run 99242 to 99245, and inpatient or observation consultations run 99252 to 99255. A consultation with straightforward medical decision making is reported with 99242 in the office and 99252 in the hospital. Separately, Medicare has not recognized consultation codes at all since 2010; for Medicare patients report the appropriate office visit or hospital care code instead, while many commercial payers still recognize and often pay more for consultations.

What replaced them

Setting	Straightforward	Low	Moderate	High
Office or outpatient	99242 (1.08)	99243 (1.80)	99244 (2.69)	99245 (3.75)
Inpatient or observation	99252 (1.42)	99253 (2.27)	99254 (3.29)	99255 (4.00)

The level 1 codes were removed because the four remaining levels map cleanly onto the four medical decision making tiers. If you are looking for the consultation code for straightforward decision making, it is 99242 in the office and 99252 in the hospital.

What Medicare wants instead

Medicare has not recognized consultation codes since 2010, regardless of how well the consultation is documented. For a Medicare patient, report the office or outpatient visit code that fits, 99202 to 99215, or in the hospital the initial or subsequent care code. The work is the same; only the code family changes.

Many commercial payers do still recognize consultations, and they frequently pay more than the equivalent visit code, which is why the question is worth getting right rather than defaulting to a standard visit for everyone.

The three things a consultation note must show

A consultation is not simply a new patient sent by someone else. Three elements have to be visible in the record: the request from another clinician and the reason for it, the opinion or advice you rendered, and the written report back to the requesting clinician. If you assume ongoing care of the problem from the start, that is a transfer of care, not a consultation.

Language that carries it: "Dr. Ramirez asked me to evaluate this patient's left lower quadrant pain. My impression and recommendations are below, and a copy of this note has been sent to Dr. Ramirez."

Levels are set by MDM or time

Like other visits since the 2021 and 2023 revisions, consultation levels are chosen by medical decision making or by total time on the date of the encounter, whichever supports the higher level. History and examination no longer drive the level; they are performed as medically appropriate.

Check it against your own note

Paste a de-identified note into the E/M Assistant and answer the consultation question when it appears; the tool will apply the payer rules and write the attestation language. The full chapter is Consultation Codes.