CPT 99449E&M

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CPT 99449 covers interprofessional phone, internet, or electronic health record consultations lasting 31 minutes or more between healthcare providers to coordinate patient care. This allows specialists to bill for time spent consulting with other physicians about complex patient cases remotely.

Showing rates for

National Average

Base Medicare rate

$69.54

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

Work RVU

1.4

PE RVU (NF)

0.63

MP RVU

0.12

Total RVU

2.15

Conversion factor: 32.3465 · Source: CMS MPFS RVU25A · Confidence: High

NCCI bundling edits

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Billing tips

Document exact start and stop times for all consultation activities including EHR review, phone discussion, and report preparation to substantiate the 31+ minute threshold
Impact: Prevents denials for insufficient time documentation; time-based coding errors account for 30-40% of 99449 denials
Ensure the treating/requesting physician's name, patient information, and specific clinical question are documented in your consultation note
Impact: Required elements for payment; missing requesting provider information results in automatic denial in most payer systems
Bill 99449 only once per patient encounter regardless of multiple phone calls or EHR reviews if they relate to the same clinical question within the same timeframe
Impact: Prevents unbundling allegations; duplicate billing can trigger recoupment of $69.54 plus potential fraud investigation
Verify that the treating physician has not billed care plan oversight or chronic care management codes for the same time period, as these services may overlap
Impact: Prevents duplicate service denials; overlapping claims may result in both claims being rejected
Submit a written report to the treating provider and maintain a copy in your records; verbal-only consultations do not meet billing requirements
Impact: Written report is a mandatory element; absence results in 100% denial with difficult appeal prospects
Check payer-specific policies as some commercial payers do not recognize interprofessional consultation codes or require prior authorization
Medicare covers 99449 but commercial payer coverage varies from 40-90%; verify before service to avoid write-offs

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Frequently asked questions

What is CPT code 99449 used for?

CPT 99449 is used to bill for interprofessional telephone, internet, or EHR consultations between healthcare providers lasting 31 minutes or more. It allows consulting specialists to receive payment for assessing patient information and providing medical recommendations to the treating physician without a face-to-face patient encounter.

How much does Medicare pay for CPT 99449 in 2025?

Medicare pays $69.54 for CPT 99449 in 2025 based on the national average payment rate. Both facility and non-facility rates are $69.54, with a total RVU of 2.15 (1.4 work RVU, 0.63 practice expense RVU, and 0.12 malpractice RVU).

What is the difference between CPT 99449 and 99448?

The difference is consultation duration: CPT 99448 covers interprofessional consultations of 21-30 minutes, while CPT 99449 covers consultations of 31 minutes or more. Both require the same documentation elements including verbal discussion and written report, but 99449 has higher reimbursement due to increased time investment.

Does CPT 99449 require a written report?

Yes, CPT 99449 requires both verbal communication and a written report to the treating/requesting physician. The written report is a mandatory element; consultations with only verbal communication do not meet the billing requirements and will be denied.

Can you bill 99449 for consultation with a patient?

No, CPT 99449 is exclusively for provider-to-provider consultation and does not involve direct patient contact. If you are consulting directly with a patient via telephone or telehealth, you should use appropriate E&M codes (office visit, telehealth visit, or telephone E&M codes) instead.

How do you document time for CPT 99449?

Document the start and stop times for all consultation-related activities including reviewing patient records, telephone or internet discussion with the requesting provider, and preparing the written report. Total time must equal or exceed 31 minutes, and documentation should itemize each component with specific timestamps to support the time-based coding.

Do commercial insurance companies pay for CPT 99449?

Commercial payer coverage for CPT 99449 varies significantly. While Medicare recognizes this code, many commercial payers have limited or no coverage for interprofessional consultation codes. Verify coverage with each specific payer before providing the service, as reimbursement rates range from denial to amounts comparable to Medicare's $69.54, depending on the contract.