The short version
- CPT 99451 — the specialist bills this for a written eConsult opinion (≥5 minutes of consultative work).
- CPT 99452 — the treating provider bills this for ≥16 minutes spent preparing the case and reviewing the specialist's input.
- Medicare's 2024 national-average allowed amount is roughly the same for each code; commercial payer rates vary. Always verify current rates with the source [1][2].
- Patient consent is required and should be documented in the chart, along with any cost-sharing.
What CPT 99451 covers
CPT 99451 is billed by the consulting specialist for an interprofessional assessment and management service provided by telephone, internet, or EHR — when the specialist delivers a written report back to the requesting provider and spends 5 or more minutes of medical consultative time [1].
What CPT 99452 covers
CPT 99452 is billed by the treating/requesting provider — the clinician managing the patient — for preparing the case and reviewing the specialist's response. The descriptor requires 16–30 minutes in a service day [1].
Why this matters
Before 99451/99452 existed, the work of asking a specialist a question and acting on the answer was unbilled time. These codes recognize that work and create a documented, accountable alternative to the informal curbside consult [3].
References
- 1.American Medical Association. CPT Professional 2024 — Interprofessional Telephone/Internet/Electronic Health Record Consultations (99446–99449, 99451, 99452). AMA, 2023. https://www.ama-assn.org/practice-management/cpt
- 2.Centers for Medicare & Medicaid Services. Medicare Physician Fee Schedule — final rule (CY 2024). Federal Register, Nov 2023. https://www.cms.gov/medicare/payment/fee-schedules/physician
- 3.American Academy of Family Physicians. Coding interprofessional consultations (99446–99452). FPM, 2022. https://www.aafp.org/pubs/fpm/issues.html
This article is for general educational purposes only and is not medical, legal, billing, or coding advice. Reimbursement rules and amounts vary by payer, state, and year — confirm with a qualified billing professional and your payer's current policy before acting on anything here.
See how Beam approaches this in practice
Beam runs same-day specialist consults documented in the chart. The fit depends on your setting and payer mix — happy to walk through it.