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99245 CPT Code: 2026 Billing, Documentation, MDM, Time, and Payer Rules

CPT 99245 outpatient consultation billing 2026 hero banner: high MDM or 55-minute time threshold, the highest level in the 99242-99245 family, 99417 prolonged service add-on starting at 70 minutes with no partial credit, Medicare's non-recognition since 2010, and payer-specific consultation policy verification, from ClaimMax RCM.

The 99245 CPT code is the highest-level office or other outpatient consultation for a new or established patient. Code selection requires high medical decision making, or at least 55 minutes of total physician or qualified health professional time on the date of the encounter. Traditional Medicare does not recognize outpatient consultation codes for Part B […]