# CPT 99245: Office or outpatient consultation, high medical decision making

Medicare CPT 99245 pays $209.42 in a non-facility setting and $178.69 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $195.03 in Arkansas to $273.74 in Alaska, a 40% spread.

Web page: https://www.med-reveal.com/rates/99245-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Clinical Genetics (M.D.), Evaluation, Infectious Disease, Optometrist, Pulmonary Disease, Thoracic Surgery (Cardiothoracic Vascular Surgery)

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $209.42 |
| National facility | $178.69 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $273.74 | $241.02 |
| District of Columbia | $230.69 | $194.49 |
| New York | $226.88 | $192.60 |
| New Jersey | $226.16 | $191.56 |
| California | $224.63 | $188.27 |
| Washington | $222.58 | $187.55 |
| Massachusetts | $221.33 | $186.81 |
| Connecticut | $219.39 | $186.29 |
| Hawaii | $216.85 | $181.92 |
| Florida | $216.64 | $185.80 |
| Maryland | $214.89 | $182.86 |
| Colorado | $214.23 | $181.54 |
| Illinois | $213.97 | $184.27 |
| Rhode Island | $213.54 | $181.80 |
| Oregon | $212.50 | $180.13 |
| New Hampshire | $211.65 | $179.67 |
| Puerto Rico | $210.16 | $179.09 |
| Virgin Islands | $210.16 | $179.09 |
| Pennsylvania | $209.49 | $179.39 |
| Montana | $209.41 | $178.68 |
| Texas | $208.40 | $178.15 |
| Delaware | $208.39 | $178.03 |
| Nevada | $208.27 | $177.51 |
| Michigan | $207.74 | $178.88 |
| Georgia | $207.52 | $178.21 |
| Wyoming | $207.51 | $176.78 |
| Minnesota | $206.48 | $174.86 |
| Arizona | $205.98 | $176.21 |
| Virginia | $205.96 | $175.75 |
| North Dakota | $205.06 | $174.33 |
| Vermont | $205.03 | $174.60 |
| South Dakota | $204.54 | $173.82 |
| New Mexico | $204.52 | $176.35 |
| Utah | $204.06 | $175.18 |
| Maine | $203.26 | $173.90 |
| Louisiana | $203.08 | $175.03 |
| Missouri | $202.98 | $174.78 |
| Ohio | $202.80 | $174.74 |
| West Virginia | $202.53 | $175.82 |
| South Carolina | $202.48 | $174.09 |
| North Carolina | $201.62 | $172.95 |
| Wisconsin | $201.11 | $171.67 |
| Kentucky | $200.27 | $172.95 |
| Indiana | $200.04 | $171.55 |
| Oklahoma | $199.57 | $172.12 |
| Idaho | $199.41 | $171.13 |
| Tennessee | $199.03 | $171.10 |
| Nebraska | $198.94 | $170.58 |
| Iowa | $198.46 | $170.35 |
| Kansas | $198.40 | $170.63 |
| Mississippi | $196.83 | $170.37 |
| Alabama | $196.63 | $169.74 |
| Arkansas | $195.03 | $168.63 |

## Related codes

- 99242: Office or outpatient consultation, low medical decision making — https://www.med-reveal.com/rates/99242-cpt-fee-schedule
- 99243: Office or outpatient consultation, moderate medical decision making (lower) — https://www.med-reveal.com/rates/99243-cpt-fee-schedule
- 99244: Office or outpatient consultation, moderate medical decision making — https://www.med-reveal.com/rates/99244-cpt-fee-schedule
- 99252: Inpatient or observation consultation, straightforward to low medical decision making — https://www.med-reveal.com/rates/99252-cpt-fee-schedule
- 99253: Inpatient or observation consultation, low medical decision making — https://www.med-reveal.com/rates/99253-cpt-fee-schedule
- 99254: Inpatient or observation consultation, moderate medical decision making — https://www.med-reveal.com/rates/99254-cpt-fee-schedule
- 99255: Inpatient or observation consultation, high medical decision making — https://www.med-reveal.com/rates/99255-cpt-fee-schedule

Commercial negotiated rates for 99245 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules