The short version
- CPT 99451 is billed by the consulting specialist for a written interprofessional consult of five or more minutes of medical consultative time [1].
- National Medicare allowable is roughly $37 per consult; many commercial payers pay equal or more [2].
- The patient must consent, the request must come from the treating provider, and the specialist must send a written report.
What CPT 99451 actually covers
The CPT descriptor for 99451 is "Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician, including a written report to the patient's treating/requesting physician or other qualified health care professional, 5 minutes or more of medical consultative time." [1]
Translation: a board-certified specialist reviews a case at the treating provider's request and sends a written report back. The specialist never sees the patient. The work is asynchronous.
Who can bill it
- Physicians (MD, DO) board-certified in the specialty being consulted on.
- Other qualified health care professionals when permitted by state scope and payer policy.
- Only the consulting side bills 99451. The treating provider bills 99452 on their side — see CPT 99452 deep dive.
Documentation requirements
- Patient consent — verbal consent (including any cost-share) documented in the chart by the treating provider.
- A clear request from the treating provider with the clinical question.
- A written report from the specialist back to the treating provider, in the chart.
- Time documentation — at least five minutes of medical consultative time.
- No separate visit with the same specialist for the same problem within 14 days before or after.
What 99451 pays
National Medicare allowable for CPT 99451 is approximately $37 per consult under the most recent Medicare Physician Fee Schedule [2]. Commercial payer rates vary; many pay at or above the Medicare rate. State Medicaid coverage is uneven — confirm with each payer before relying on it as a steady revenue line.
Frequency limits and common rejections
- CPT 99451 should not be billed more than once per 7-day period for the same patient by the same specialist.
- Cannot be billed when the specialist has an in-person or telehealth visit with the patient for the same problem within 14 days before or after.
- The most common denials are missing consent, missing time, or a missing written report in the chart [3].
Frequently asked
What is CPT 99451?
CPT 99451 is the interprofessional internet/EHR consultation code billed by a consulting specialist for a written assessment and report of 5 or more minutes of medical consultative time, at the request of a treating provider.
How much does Medicare pay for 99451?
National Medicare allowable is approximately $37 per consult under the current Medicare Physician Fee Schedule. Geographic adjustments apply. Commercial payer rates vary — many pay at or above the Medicare rate.
Can a nurse practitioner bill CPT 99451?
Yes, when acting as the consulting specialist and where permitted by state scope and payer policy. The code is open to physicians and other qualified health care professionals on the consulting side.
How often can 99451 be billed for the same patient?
Once per 7-day period for the same patient by the same specialist. It cannot be billed when the specialist sees the same patient face-to-face or via telehealth for the same problem within 14 days before or after.
References
- 1.American Medical Association. CPT Professional 2024 — 99451 descriptor and time thresholds. 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. 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.