PFS ExplorerMedicare Physician Fee Schedule · 2026

Search codes

Search for a command to run...

Model Your Practice

99245

Off/op consltj new/est hi 55

Add to my model
Code typePrimary
Payment statusNot valid for Medicare (I)
Global periodNone
Not valid for Medicare: Medicare uses a different code to report and pay for this service.

Pricing with Related Codes

Line
Qty
Global fee
Pro fee
Primary99245Off/op consltj new/est hi 55
1
$0.00
$0.00
Add-on90833Psytx w pt w e/m 30 min
0
$81.50/ unit
$65.80/ unit
Add-on90836Psytx w pt w e/m 45 min
0
$103.21/ unit
$83.17/ unit
Add-on90838Psytx w pt w e/m 60 min
0
$136.61/ unit
$110.22/ unit
Add-on96160Pt-focused hlth risk assmt
0
$3.01/ unit
$3.01/ unit
Add-on96161Caregiver health risk assmt
0
$3.34/ unit
$3.34/ unit
Add-on99417Prolng op e/m each 15 min
0
$0.00/ unit
$0.00/ unit
Add-on99459Pelvic examination
0
$17.37/ unit
$17.37/ unit
Whole procedure · 0.00 wRVU credited
$0.00
$0.00
How these numbers were computed
  • status=IThis code is not separately payable under the Physician Fee Schedule (status I) — amounts shown are $0.

RVU Breakdown

Component
Office
Facility
Work
3.75
3.75
Practice expense
2.30
1.38
Malpractice
0.22
0.22
Total RVU
6.27
5.35

Payment Policy & Modifiers

Allowed adjustments
No payment adjustments apply to this code.
Not applicable to this code
Bilateral -50Multiple procedure Assistant surgeon Co-surgeon -62Team surgeon -66Prof / tech split