Inpatient or observation consultation, straightforward decision making, 35 minutes

Description

This code is used for an inpatient or observation consultation involving a new or established patient. The encounter includes straightforward medical decision making or requires at least 35 minutes of total time spent with the patient on a single date.

Medicare Hospital Outpatient Reimbursement (OPPS)

OPPS Payment Rate

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Patient Copayment / Coinsurance

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Top Modifiers

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HCPCS/CPT 25Significant, separately identifiable evaluation and management service on the same day(9.63%)

HCPCS/CPT GCServices performed by a resident under the supervision of a teaching physician(8.52%)

HCPCS/CPT 57Evaluation and management service resulting in decision for surgery(2.22%)

HCPCS/CPT FSSplit or shared evaluation and management visit(1.11%)

HCPCS/CPT CCProcedure code change due to administrative or filing error(0.74%)

HCPCS/CPT GYItem or service excluded from Medicare benefits(0.37%)

HCPCS/CPT GVAttending physician not employed by hospice provider(0.37%)

HCPCS/CPT 24Unrelated evaluation and management service during postoperative period(0.37%)

HCPCS/CPT LTModifier for procedures performed on the left side of the body(0.37%)

HCPCS/CPT AIPrincipal physician of record modifier(0.37%)

Code Crosswalks

No crosswalks found.

Alternate Codes

No alternates found.

Billed With Codes

No codes found here.

Sources

We make no claims to ownership of the coding systems referenced on this platform. Codes and descriptions are produced from claims and chargemaster data available through the CMS-9915-F Transparency in Coverage Final Rule and via state or federal datasets. This service is provided solely as a reference to encourage use of these codes in our chargemaster review and automated billing tools, so that healthcare professionals can understand and correctly report these codes in their claims.

Federal and State Datasets

List of CPT/HCPCS Codes, Centers for Medicare & Medicaid Services (CMS)
I/OCE Quarterly Release Files, Centers for Medicare & Medicaid Services (CMS)
Physician Fee Schedule Relative Value Files, Centers for Medicare & Medicaid Services (CMS)
OPPS Addendum B, Centers for Medicare & Medicaid Services (CMS)
ASC Payment Addenda, Centers for Medicare & Medicaid Services (CMS)