# CPT 99254: Inpatient or observation consultation, moderate medical decision making

Medicare CPT 99254 pays $137.61 in a non-facility setting and $137.61 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $129.07 in Arkansas to $183.16 in Alaska, a 42% spread.

Web page: https://www.med-reveal.com/rates/99254-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation, Infectious Disease, Pulmonary Disease

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $137.61 |
| National facility | $137.61 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $183.16 | $183.16 |
| District of Columbia | $150.47 | $150.47 |
| New York | $148.71 | $148.71 |
| New Jersey | $147.94 | $147.94 |
| California | $145.80 | $145.80 |
| Washington | $145.03 | $145.03 |
| Massachusetts | $144.39 | $144.39 |
| Connecticut | $143.78 | $143.78 |
| Florida | $143.12 | $143.12 |
| Illinois | $141.72 | $141.72 |
| Maryland | $140.98 | $140.98 |
| Hawaii | $140.85 | $140.85 |
| Colorado | $140.09 | $140.09 |
| Rhode Island | $140.08 | $140.08 |
| Oregon | $138.96 | $138.96 |
| New Hampshire | $138.59 | $138.59 |
| Pennsylvania | $137.98 | $137.98 |
| Puerto Rico | $137.98 | $137.98 |
| Virgin Islands | $137.98 | $137.98 |
| Montana | $137.60 | $137.60 |
| Michigan | $137.42 | $137.42 |
| Texas | $137.07 | $137.07 |
| Delaware | $137.00 | $137.00 |
| Georgia | $136.97 | $136.97 |
| Nevada | $136.70 | $136.70 |
| Wyoming | $136.14 | $136.14 |
| Arizona | $135.52 | $135.52 |
| New Mexico | $135.34 | $135.34 |
| Virginia | $135.24 | $135.24 |
| Minnesota | $134.81 | $134.81 |
| West Virginia | $134.68 | $134.68 |
| Utah | $134.57 | $134.57 |
| Vermont | $134.40 | $134.40 |
| Louisiana | $134.31 | $134.31 |
| North Dakota | $134.24 | $134.24 |
| Missouri | $134.14 | $134.14 |
| Ohio | $134.08 | $134.08 |
| South Dakota | $133.84 | $133.84 |
| Maine | $133.67 | $133.67 |
| South Carolina | $133.64 | $133.64 |
| North Carolina | $132.81 | $132.81 |
| Kentucky | $132.57 | $132.57 |
| Wisconsin | $131.96 | $131.96 |
| Oklahoma | $131.95 | $131.95 |
| Indiana | $131.69 | $131.69 |
| Idaho | $131.33 | $131.33 |
| Tennessee | $131.24 | $131.24 |
| Nebraska | $130.92 | $130.92 |
| Kansas | $130.85 | $130.85 |
| Iowa | $130.70 | $130.70 |
| Mississippi | $130.42 | $130.42 |
| Alabama | $130.01 | $130.01 |
| Arkansas | $129.07 | $129.07 |

## 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
- 99245: Office or outpatient consultation, high medical decision making — https://www.med-reveal.com/rates/99245-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
- 99255: Inpatient or observation consultation, high medical decision making — https://www.med-reveal.com/rates/99255-cpt-fee-schedule

Commercial negotiated rates for 99254 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