CPT 99451E&M

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CPT 99451 is used when a doctor consults with another healthcare professional by phone or electronically to get their opinion on a patient's case, taking 5 minutes or more. This is for expert-to-expert communication, not for talking directly with patients.

Showing rates for

National Average

Base Medicare rate

$32.99

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

0.7

PE RVU (NF)

0.28

MP RVU

0.04

Total RVU

1.02

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

NCCI bundling edits

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Billing tips

Document the exact time spent in consultation - start and stop times or total duration must be clearly recorded since 5 minutes is the threshold for billing
Impact: Missing time documentation is the #1 cause of denial; proper documentation protects the full $32.99 reimbursement
Ensure a written report is created and sent to the requesting physician within 2 business days; verbal-only consultations do not qualify for 99451
Impact: Lack of written report results in 100% denial; written documentation is an absolute requirement per CPT guidelines
Verify that you have not seen the patient face-to-face within 14 days before or after the consultation, as this makes the service non-billable
Impact: 14-day rule violation leads to automatic denial; consider using traditional consultation codes instead if face-to-face contact exists
Bill 99451 only once per patient per consultant within a 14-day period, even if multiple communications occur regarding the same case
Impact: Multiple billings within 14 days will be bundled or denied; time across multiple contacts cannot be aggregated
Confirm the requesting provider has obtained patient consent for the interprofessional consultation as required by CPT guidelines
Impact: Missing patient consent can result in compliance issues and potential recoupment of payments during audits
Use specific diagnosis codes that clearly demonstrate medical necessity for specialty consultation; generic or routine diagnoses may trigger denials
Impact: Medical necessity denials can reduce reimbursement; complex or specific ICD-10 codes support the need for specialist input

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Frequently asked questions

What is CPT code 99451 used for?

CPT 99451 is used for interprofessional telephone, internet, or EHR consultations between physicians where one doctor requests another doctor's expert opinion on a patient's care. The consulting physician spends at least 5 minutes reviewing the case and provides a written report back to the requesting physician without seeing the patient directly.

How much does Medicare pay for CPT 99451 in 2025?

Medicare pays $32.99 for CPT 99451 in 2025 (national average for both facility and non-facility settings). The code has 1.02 total RVUs (0.7 work RVU, 0.28 practice expense RVU, 0.04 malpractice RVU) multiplied by the 2025 conversion factor of 32.3465.

Can I bill 99451 if I see the patient in person?

No, you cannot bill 99451 if you have seen the patient face-to-face within the 14 days before the consultation or if you see them within 14 days after. If face-to-face contact occurs within this window, you must use traditional evaluation and management codes instead.

Is a written report required for CPT 99451?

Yes, a written report is absolutely required for CPT 99451. The consulting physician must provide a written report to the requesting physician, typically within 2 business days. Verbal-only consultations do not meet the requirements for billing this code.

How much time is required to bill 99451?

A minimum of 5 minutes of medical consultative time is required to bill CPT 99451. This includes time spent reviewing patient information and communicating with the requesting provider. You must document the actual time spent, either with start/stop times or total duration.

Can I bill 99451 multiple times for the same patient?

You can only bill 99451 once per patient per consultant within a 14-day period. If you have multiple communications about the same patient case within 14 days, you cannot bill separately for each communication or aggregate the time across multiple contacts.

What specialties commonly use CPT code 99451?

CPT 99451 is commonly used by medical specialists who provide expert consultations to other physicians, including cardiologists, infectious disease physicians, endocrinologists, rheumatologists, pulmonologists, nephrologists, and other specialists who frequently receive requests for clinical opinions without needing to see patients face-to-face.