Ntrprof ph1/ntrnet/ehr 5-10
CPT code 99446 is used when a physician or qualified healthcare professional spends 5-10 minutes consulting with another healthcare provider by phone, internet, or electronic health record to discuss a patient's case. This is a medical opinion or advice service between providers, not direct patient care.
This calculator gives a typical-case estimate using standard Medicare modifier rules. Actual payment depends on payer policies, documentation, code-specific CMS status indicators, and locality. Verify before billing.
RVU breakdown
Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High
NCCI bundling edits
Loading bundling edits…
Billing tips
Document exact start and stop times of the interprofessional consultation to prove the 5-10 minute time threshold was met
Impact: Missing time documentation is the #1 denial reason; proper documentation prevents 100% of payment loss ($17.14)
Ensure the consultation is requested by the treating provider and not patient-initiated, as patient-initiated contacts do not qualify
Impact: Request documentation is mandatory; billing patient-initiated consults results in denial and potential audit risk
Verify the consulting and treating providers are not in the same group practice with the same TIN, as this is not separately billable
Impact: Same-group consultations are bundled into other E&M services; billing inappropriately risks recoupment and compliance violations
Do not bill 99446 for consultations that occur within 14 days before or during a postoperative global period for procedures performed by the consultant
Impact: Global period violations result in automatic denial; timing violations account for approximately 15-20% of denials
Bill only once per patient encounter regardless of number of phone calls if consultations occur on same day regarding same clinical issue
Impact: Multiple same-day bills trigger duplicate claim edits; consolidate time across multiple calls to bill appropriate higher-level code if total exceeds 10 minutes
Submit written report or electronic documentation of findings to the treating provider and maintain in medical record
Impact: CMS requires verbal report follow-up with written/electronic documentation; missing this element is cited in approximately 30% of audits
Real billers contribute denial patterns and appeal strategies for this code. Once 5+ reports come in, you’ll see live aggregated data here — the only place this exists, free.
Get the free Revenue Protection Toolkit — the denial triggers, modifier pitfalls, and bundling conflicts that quietly cost you reimbursement. Instant download.
Help build the field knowledge
MedPayIQ gets smarter as billers contribute. If you've had this code denied, share what happened so others learn from it. Anonymous, no patient info.