# CPT 99255: Inpatient or observation consultation, high medical decision making

Medicare CPT 99255 pays $184.71 in a non-facility setting and $184.71 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $174.20 in Arkansas to $248.85 in Alaska, a 43% spread.

Web page: https://www.med-reveal.com/rates/99255-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation, Infectious Disease, Pulmonary Disease

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $184.71 |
| National facility | $184.71 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $248.85 | $248.85 |
| District of Columbia | $201.10 | $201.10 |
| New York | $199.14 | $199.14 |
| New Jersey | $198.04 | $198.04 |
| California | $194.62 | $194.62 |
| Washington | $193.89 | $193.89 |
| Massachusetts | $193.12 | $193.12 |
| Connecticut | $192.60 | $192.60 |
| Florida | $192.14 | $192.14 |
| Illinois | $190.54 | $190.54 |
| Maryland | $189.02 | $189.02 |
| Hawaii | $188.06 | $188.06 |
| Rhode Island | $187.91 | $187.91 |
| Colorado | $187.65 | $187.65 |
| Oregon | $186.19 | $186.19 |
| New Hampshire | $185.72 | $185.72 |
| Pennsylvania | $185.41 | $185.41 |
| Puerto Rico | $185.12 | $185.12 |
| Virgin Islands | $185.12 | $185.12 |
| Michigan | $184.90 | $184.90 |
| Montana | $184.69 | $184.69 |
| Georgia | $184.20 | $184.20 |
| Texas | $184.12 | $184.12 |
| Delaware | $184.00 | $184.00 |
| Nevada | $183.47 | $183.47 |
| Wyoming | $182.71 | $182.71 |
| New Mexico | $182.26 | $182.26 |
| Arizona | $182.11 | $182.11 |
| West Virginia | $181.72 | $181.72 |
| Virginia | $181.63 | $181.63 |
| Utah | $181.04 | $181.04 |
| Louisiana | $180.88 | $180.88 |
| Minnesota | $180.69 | $180.69 |
| Missouri | $180.63 | $180.63 |
| Ohio | $180.58 | $180.58 |
| Vermont | $180.43 | $180.43 |
| North Dakota | $180.14 | $180.14 |
| South Carolina | $179.90 | $179.90 |
| Maine | $179.70 | $179.70 |
| South Dakota | $179.61 | $179.61 |
| Kentucky | $178.72 | $178.72 |
| North Carolina | $178.71 | $178.71 |
| Oklahoma | $177.85 | $177.85 |
| Wisconsin | $177.37 | $177.37 |
| Indiana | $177.25 | $177.25 |
| Idaho | $176.81 | $176.81 |
| Tennessee | $176.77 | $176.77 |
| Kansas | $176.28 | $176.28 |
| Nebraska | $176.23 | $176.23 |
| Mississippi | $176.02 | $176.02 |
| Iowa | $175.99 | $175.99 |
| Alabama | $175.36 | $175.36 |
| Arkansas | $174.20 | $174.20 |

## 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
- 99254: Inpatient or observation consultation, moderate medical decision making — https://www.med-reveal.com/rates/99254-cpt-fee-schedule

Commercial negotiated rates for 99255 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