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

99255 CPT Code: Billing, Documentation, and Medicare Replacement Rules

CPT 99255 inpatient consultation billing 2026 hero banner: high MDM or 80-minute time threshold, the highest level in the 99252-99255 family, no automatic Medicare crosswalk to 99223 despite the 75-minute floor, 99418 prolonged service starting at 95 minutes versus Medicare's G0316, and payer-specific consultation recognition rules, from ClaimMax RCM.

CPT code 99255 reports a level 5 consultation for a hospital inpatient, an observation patient, a nursing facility resident, or a partial hospital patient. The encounter has to support high medical decision making (MDM), or at least 80 minutes of total time on the date of the encounter. The code is still active in 2026, […]