CPT® code 99244 is used to report an office or outpatient consultation of typically 40 minutes for a new or established patient that involves moderate to high-complexity medical decision-making. This code applies when the provider is asked to render an opinion or advice regarding evaluation and/or management of a specific problem.
Key facts about CPT® code 99244
- Service type: Outpatient consultation
- Time requirement: Typically 40 minutes
- Patient type: New or established
- Complexity: Moderate to high
- Setting: Office or other outpatient facility
- Typical provider: Specialists or consultants receiving a formal request from another provider
When to use CPT® 99244
CPT® 99244 is appropriate when:
- A physician or qualified healthcare professional is formally requested by another provider (or qualified source) to evaluate a specific clinical issue.
- The encounter requires moderate to high-level medical decision-making (e.g., diagnosis is uncertain, multiple options are being considered, or risk of complications is significant).
- The provider conducts a comprehensive review, examination, and formulates an assessment and treatment plan, often including differential diagnoses or referral recommendations.
The requesting provider must document the request and the consulting provider must document their findings and recommendations in the patient's record and communicate back to the referring clinician.
Clinical examples of CPT® 99244
CPT® 99244 is commonly used in situations such as:
- A primary care provider refers a patient with new-onset hypertension and lab abnormalities to a nephrologist for evaluation.
- A psychiatrist is consulted to assess complex mood symptoms in a patient with significant comorbidities.
- An integrative medicine specialist is asked to provide input on chronic fatigue and autoimmune symptoms that have been difficult to manage.
- An OB/GYN consults with a reproductive endocrinologist for infertility workup and second-line treatment options.
Documentation requirements
To report CPT® 99244 accurately, documentation should include:
- A clear record of the request for consultation, including source and reason
- A detailed history and physical exam
- Moderate to high-level medical decision-making, supported by clinical notes
- An assessment with diagnostic considerations and treatment options
- Evidence of a report or communication back to the requesting provider
Although time (typically 40 minutes) can be a factor, 99244 is most often billed based on complexity of MDM under 2021 CMS guidelines.
Payer considerations
Some insurers, including Medicare, no longer recognize outpatient consultation codes like 99244, instead encouraging use of new or established office visit codes (e.g., 99204 or 99214) depending on the situation. However, many commercial payers and private plans still reimburse for 99244, especially in specialist-driven care settings.
As always, providers should verify coverage and coding preferences with each payer, and ensure consultation criteria are met.
How OptiMantra supports coding for 99244
For specialty and integrative practices that frequently handle referrals, OptiMantra’s EMR system streamlines the consultation workflow, helping providers confidently code and bill for CPT® 99244 when appropriate. With OptiMantra, you can:
- Track incoming referral sources and attach them directly to the visit
- Document comprehensive history, exams, and MDM using specialty-specific templates
- Automatically link diagnoses, clinical notes, and CPT® codes for accurate billing
- Create and share consultation summaries with the referring provider from within the platform
- Review payer-specific coding guidance with built-in prompts and alerts
Whether you're a functional medicine provider, integrative specialist, or conventional consultant, OptiMantra helps ensure your consults are documented thoroughly, billed accurately, and easy to manage from intake to follow-up.
Try OptiMantra for free here!
