What is medical code 99245?

Answer 1

99245 is a CPT evaluation and management code for an: Office (or other outpatient) consultation for a new or established patient with a comprehensive history and examination, and medical decision making of high complexity.

Answer 2

CPT code 99245 refers to office consultationfor a new or established patient, which requires these 3 key components:

• A comprehensive history;
• A comprehensive examination; and
• Medical decision making of high complexity.

Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Typically, 80 minutes are spent face-to-face with the patient and/or family.

The provider performs a consultation at the request of another provider. When selecting an E/M service level for an office consultation, there are three key components that must be met in order to report the code appropriately. These components are in addition to the medical necessity for performing the procedure(s).

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