Floating Contact
Text Message
+1 (916) 299-5335

99243 CPT Code: 2026 Billing, Medicare, and Documentation Guide

CPT 99243 outpatient consultation billing 2026 hero banner: low MDM or 30-minute time threshold, Medicare's non-recognition of the 99242-99245 family, time-based crosswalk to 99214 instead of 99213, modifier 25 same-day procedure rules, and the March 2026 OIG modifier 25 audit initiative, from ClaimMax RCM.

The 99243 CPT code reports an office or other outpatient consultation for a new or established patient, selected by low medical decision making or at least 30 minutes of total time on the encounter date. CPT 99243 is still an active code. Medicare Part B doesn’t recognize it for payment, and CMS instructs providers to […]