CPT 99452E&M

Ntrprof ph1/ntrnet/ehr rfrl

CPT 99452 covers when your doctor consults with another healthcare professional by phone or internet about your care, spending 5-10 minutes discussing your case. This is a specialist-to-specialist communication about treatment recommendations, not a patient visit.

Showing rates for

National Average

Base Medicare rate

$33.64

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)

0.3

MP RVU

0.04

Total RVU

1.04

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 (5-10 minutes required for 99452; 11-20 minutes requires 99451, 21-30 minutes requires 99449)
Impact: Incorrect time documentation is the #1 denial reason; undercoding by one level loses $37.26 in revenue
Ensure a written report is sent to the requesting physician and retained in medical records
Impact: Missing written documentation results in 85% claim denial rate per CERT audits
Verify the requesting and consulting physicians have different tax IDs before billing
Impact: Same-group consultations are bundled and not separately billable, resulting in 100% claim denial
Bill only once per patient per consultation episode; do not bill for follow-up discussions about the same issue within 14 days
Impact: Duplicate billing within the consultation period triggers recoupment of $33.64 per occurrence
Do not bill 99452 if you assume care of the patient or see them in person within the consultation timeframe
Impact: Transfer of care negates interprofessional consultation coding; use appropriate E&M code instead
Include specific clinical question, your assessment, and recommendations in the written report
Impact: Vague or template-based reports are flagged in audits with 60% overturn rate on appeal

Common denials

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Frequently asked questions

What is CPT code 99452 used for?

CPT 99452 is used when a physician or qualified healthcare professional provides an interprofessional consultation by phone, internet, or EHR to another treating physician. The consultation must involve 5-10 minutes of medical discussion and require a written report to the requesting physician.

How much does Medicare pay for CPT 99452 in 2025?

Medicare pays $33.64 for CPT 99452 in 2025 (both facility and non-facility rates). The code has a total RVU of 1.04, with work RVU of 0.7, based on the 2025 Medicare Physician Fee Schedule.

Can I bill 99452 for a curbside consultation?

No. CPT 99452 requires a formal interprofessional consultation with a written report sent to the requesting physician. Informal 'curbside' consultations or brief hallway discussions without written documentation do not meet the billing requirements for this code.

What is the difference between 99452, 99451, and 99449?

The difference is consultation time: 99452 is for 5-10 minutes, 99451 is for 11-20 minutes, and 99449 is for 21-30 minutes. All require interprofessional phone/internet/EHR consultation with a written report, but billing depends on total time spent in medical discussion.

Can I bill 99452 if I work in the same clinic as the requesting physician?

No, if you share the same tax ID or are part of the same group practice. CPT 99452 can only be billed when the consulting and requesting physicians are from different group practices with different tax identification numbers.

Does CPT 99452 require a written report?

Yes, a written report is mandatory for billing 99452. The consultant must provide written documentation of their assessment and recommendations to the requesting physician, and this report must be retained in the medical record.

How often can I bill CPT 99452 for the same patient?

You can bill 99452 once per consultation episode. You cannot bill again for follow-up discussions about the same clinical issue within 14 days. A new consultation code can be billed only when addressing a distinctly different clinical question or new medical problem.