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99442 is retired—last valid Dec 31, 2024.

The figures below are from Q4 2024, the last release that carried this code. They are here for checking a claim from that period—this code cannot be billed for dates of service after Dec 31, 2024.

The telephone evaluation-and-management family was restructured for 2025.

CPT 99442

Phone Consultation

National PFS baseline · Q4 2024

99442 · Historical

GPCIs 1.000 · Participating · Before sequestration

Find the locality-adjusted allowed amount

Nationally priced under PFS, using the RVU formula.

The national PFS baseline was $90.54 for CPT 99442 in the office (non-facility) setting and $64.91 in a facility under the Q4 2024 Physician Fee Schedule, effective October 2024. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded.

Calculation evidence

Physician relative value file (Q4 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 18,637)

Compact facts

Why are the facility and non-facility amounts different?

Only the practice-expense RVU changes with the setting. For 99442 it's 1.33 RVUs in the office versus 0.56 in a facility—the whole $25.63 gap between $90.54 and $64.91. In an office the practice bears the overhead, so Medicare pays more; in a hospital or ASC the facility bills its own fee, so the professional payment is lower. See facility vs non-facility.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Practice Expense methodology (cms.gov).

What could change this amount? Copy link

Review the applicable inputs and payment rules. Each link opens the supporting detail on this page.

Service location and setting · Participation and payment shares

Facility/non-facility Applies
Other payment indicators (9)

Professional/technical component: Does not apply, Bilateral adjustment: Does not apply, Multiple-procedure reduction: Does not apply, Assistant/co-surgeon treatment: Does not apply, Global surgery: Does not apply, NCCI same-day edits: Not determined, MUE behavior: Not determined, Other fee-schedule routing: Does not apply, Contractor pricing: Does not apply.

Compare payment localities

The national baseline uses GPCI 1.000. These locality-adjusted allowed amounts use each payment locality's own GPCIs. Select a state to see its localities.

Maine: $85.64–$90.04 across 2 localities ME Wisconsin: $86.63 WI Vermont: $88.79 VT New Hampshire: $91.74 NH Montana: $90.48 MT North Dakota: $89.09 ND Minnesota: $89.55 MN Michigan: $87.12–$92.20 across 2 localities MI New York: $87.48–$104.94 across 5 localities NY Massachusetts: $93.37–$100.76 across 2 localities MA Rhode Island: $92.90 RI Washington: $92.03–$101.70 across 2 localities WA Idaho: $84.85 ID Wyoming: $89.76 WY South Dakota: $88.69 SD Iowa: $85.06 IA Illinois: $87.79–$94.91 across 4 localities IL Indiana: $85.55 IN Ohio: $86.70 OH Pennsylvania: $87.09–$94.46 across 2 localities PA New Jersey: $97.26–$101.02 across 2 localities NJ Connecticut: $96.14 CT Oregon: $88.85–$94.73 across 2 localities OR Nevada: $90.07 NV Utah: $87.37 UT Colorado: $92.72 CO Nebraska: $84.78 NE Missouri: $84.22–$88.40 across 3 localities MO Kentucky: $84.84 KY West Virginia: $85.43 WV Virginia: $89.19 VA Maryland: $91.69–$95.79 across 2 localities MD Delaware: $90.42 DE California: $93.95–$112.81 across 29 localities CA Arizona: $89.00 AZ New Mexico: $86.98 NM Kansas: $85.00 KS Oklahoma: $85.16 OK Arkansas: $82.90 AR Tennessee: $84.57 TN North Carolina: $86.26 NC South Carolina: $86.14 SC District of Columbia: $102.01 DC Texas: $86.09–$92.51 across 8 localities TX Louisiana: $85.22–$88.13 across 2 localities LA Mississippi: $83.29 MS Alabama: $83.47 AL Georgia: $85.74–$90.79 across 2 localities GA Florida: $89.28–$96.23 across 3 localities FL Alaska: $114.54 AK Hawaii: $95.82 HI
$83–$88 $88–$93 $93–$99 $99–$104 $104–$109 $109–$115

Highest-paying locality

$114.54

AK flag Alaska , AK

Lowest-paying locality

$82.90

AR flag Arkansas, AR

99442 non-facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $114.54 Locality 02102-01 Washington, DC flag Washington, DC $102.01 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $101.02 Locality 12402-01 Hartford, CT flag Hartford, CT $96.14 Locality 13102-00 Honolulu, HI flag Honolulu, HI $95.82 Locality 01212-01 Providence, RI flag Providence, RI $92.90 Locality 14412-01 Denver, CO flag Denver, CO $92.72 Locality 04112-01
Show 24 more metros
Las Vegas, NV flag Las Vegas, NV $90.07 Locality 01312-00 Portland, ME flag Portland, ME $90.04 Locality 14112-03 Minneapolis, MN flag Minneapolis, MN $89.55 Locality 06202-00 Tampa, FL flag Tampa, FL $89.28 Locality 09102-99 Richmond, VA flag Richmond, VA $89.19 Locality 11302-00 Phoenix, AZ flag Phoenix, AZ $89.00 Locality 03102-00 San Antonio, TX flag San Antonio, TX $87.91 Locality 04412-99 Buffalo, NY flag Buffalo, NY $87.48 Locality 13282-99 Salt Lake City, UT flag Salt Lake City, UT $87.37 Locality 03502-09 Pittsburgh, PA flag Pittsburgh, PA $87.09 Locality 12502-99 Albuquerque, NM flag Albuquerque, NM $86.98 Locality 04212-05 Columbus, OH flag Columbus, OH $86.70 Locality 15202-00 Milwaukee, WI flag Milwaukee, WI $86.63 Locality 06302-00 Charlotte, NC flag Charlotte, NC $86.26 Locality 11502-00 Charleston, SC flag Charleston, SC $86.14 Locality 11202-01 Indianapolis, IN flag Indianapolis, IN $85.55 Locality 08102-00 Oklahoma City, OK flag Oklahoma City, OK $85.16 Locality 04312-00 Des Moines, IA flag Des Moines, IA $85.06 Locality 05102-00 Wichita, KS flag Wichita, KS $85.00 Locality 05202-00 Boise, ID flag Boise, ID $84.85 Locality 02202-00 Louisville, KY flag Louisville, KY $84.84 Locality 15102-00 Omaha, NE flag Omaha, NE $84.78 Locality 05402-00 Nashville, TN flag Nashville, TN $84.57 Locality 10312-35 Birmingham, AL flag Birmingham, AL $83.47 Locality 10112-00
Maine: $62.24–$64.10 across 2 localities ME Wisconsin: $62.10 WI Vermont: $63.34 VT New Hampshire: $65.24 NH Montana: $64.84 MT North Dakota: $63.46 ND Minnesota: $63.28 MN Michigan: $63.77–$66.93 across 2 localities MI New York: $63.16–$74.18 across 5 localities NY Massachusetts: $66.17–$70.08 across 2 localities MA Rhode Island: $66.27 RI Washington: $65.37–$70.43 across 2 localities WA Idaho: $61.58 ID Wyoming: $64.13 WY South Dakota: $63.06 SD Iowa: $61.66 IA Illinois: $64.41–$68.69 across 4 localities IL Indiana: $61.91 IN Ohio: $63.35 OH Pennsylvania: $63.33–$67.47 across 2 localities PA New Jersey: $68.91–$70.98 across 2 localities NJ Connecticut: $68.18 CT Oregon: $63.58–$66.46 across 2 localities OR Nevada: $64.44 NV Utah: $63.45 UT Colorado: $65.73 CO Nebraska: $61.28 NE Missouri: $62.20–$64.00 across 3 localities MO Kentucky: $62.36 KY West Virginia: $63.34 WV Virginia: $63.96 VA Maryland: $65.65–$68.16 across 2 localities MD Delaware: $65.00 DE California: $65.93–$76.03 across 29 localities CA Arizona: $64.01 AZ New Mexico: $63.71 NM Kansas: $61.78 KS Oklahoma: $62.32 OK Arkansas: $60.86 AR Tennessee: $61.61 TN North Carolina: $62.53 NC South Carolina: $62.74 SC District of Columbia: $71.46 DC Texas: $62.94–$66.80 across 8 localities TX Louisiana: $62.64–$64.17 across 2 localities LA Mississippi: $61.46 MS Alabama: $61.20 AL Georgia: $63.10–$65.24 across 2 localities GA Florida: $65.19–$69.91 across 3 localities FL Alaska: $86.84 AK Hawaii: $66.37 HI
$61–$65 $65–$70 $70–$74 $74–$78 $78–$83 $83–$87

Highest-paying locality

$86.84

AK flag Alaska , AK

Lowest-paying locality

$60.86

AR flag Arkansas, AR

99442 facility rate by metro area

Highest-paying metro first. Each figure is that payment locality's own GPCI-adjusted amount.

Anchorage, AK flag Anchorage, AK $86.84 Locality 02102-01 Washington, DC flag Washington, DC $71.46 Locality 12202-01 Northern New Jersey, NJ flag Northern New Jersey, NJ $70.98 Locality 12402-01 Hartford, CT flag Hartford, CT $68.18 Locality 13102-00 Honolulu, HI flag Honolulu, HI $66.37 Locality 01212-01 Providence, RI flag Providence, RI $66.27 Locality 14412-01 Denver, CO flag Denver, CO $65.73 Locality 04112-01
Show 24 more metros
Tampa, FL flag Tampa, FL $65.19 Locality 09102-99 Las Vegas, NV flag Las Vegas, NV $64.44 Locality 01312-00 Portland, ME flag Portland, ME $64.10 Locality 14112-03 Phoenix, AZ flag Phoenix, AZ $64.01 Locality 03102-00 Richmond, VA flag Richmond, VA $63.96 Locality 11302-00 Albuquerque, NM flag Albuquerque, NM $63.71 Locality 04212-05 San Antonio, TX flag San Antonio, TX $63.69 Locality 04412-99 Salt Lake City, UT flag Salt Lake City, UT $63.45 Locality 03502-09 Columbus, OH flag Columbus, OH $63.35 Locality 15202-00 Pittsburgh, PA flag Pittsburgh, PA $63.33 Locality 12502-99 Minneapolis, MN flag Minneapolis, MN $63.28 Locality 06202-00 Buffalo, NY flag Buffalo, NY $63.16 Locality 13282-99 Charleston, SC flag Charleston, SC $62.74 Locality 11202-01 Charlotte, NC flag Charlotte, NC $62.53 Locality 11502-00 Louisville, KY flag Louisville, KY $62.36 Locality 15102-00 Oklahoma City, OK flag Oklahoma City, OK $62.32 Locality 04312-00 Milwaukee, WI flag Milwaukee, WI $62.10 Locality 06302-00 Indianapolis, IN flag Indianapolis, IN $61.91 Locality 08102-00 Wichita, KS flag Wichita, KS $61.78 Locality 05202-00 Des Moines, IA flag Des Moines, IA $61.66 Locality 05102-00 Nashville, TN flag Nashville, TN $61.61 Locality 10312-35 Boise, ID flag Boise, ID $61.58 Locality 02202-00 Omaha, NE flag Omaha, NE $61.28 Locality 05402-00 Birmingham, AL flag Birmingham, AL $61.20 Locality 10112-00

Look up your exact locality →

Q4 2024 amounts, computed with each locality's own GPCIs, before the ~2% sequestration cut. A state with more than one payment locality shows a range—its tile is colored by the mean across those localities, which is a shading choice, not an amount anyone is paid.

Reconciling a 99442 line from a release where it was valid Copy link

99442 is not valid in the release shown, so a paid line has to be reconciled against the release that governed its own date of service.

What to reconcile

  • Check the release that governed the date of service; this code is not valid in the release shown, so an amount taken from here will not match what the payer priced.
  • Check the place-of-service code before attributing the gap to the payer: office and facility pricing differ by $25.63 nationally at GPCI 1.000, before any locality adjustment.
  • Check for documentation on file before appealing an assistant-at-surgery denial: payment on the -80 or -AS line is restricted for this procedure unless medical necessity is established.
  • Reprice the line against the release, locality, setting, modifier and participation status that applied to the date of service before treating any difference as an underpayment.

Nearby payment lines

National Q4 2024 amounts at GPCI 1.000. A blank means this schedule does not publish a payable PFS amount.

Code Why compare Office Facility
99441 Same payment rules, less physician work $56.26 $34.62
99443 Same payment rules, more physician work $128.16 $96.20
99429 Priced as non-covered rather than active — —
Check an actual payment Model this code in a contract

Sources: CMS Medicare Physician Fee Schedule Relative Value Files; CMS Medicare Physician Fee Schedule Relative Value Files (status indicator field); CMS Practice Expense methodology (cms.gov); 42 USC 1395w-4(i)(2) (SSA §1848(i)(2))—Assistants-at-surgery.

Payment rules

Modifier amounts: -26/TC, -50, -80/81/82, -AS, -62, -66 Copy link

National non-facility amounts for the modifiers this code's indicators support. Single-line modifiers only. -51 (multiple-procedure reduction) depends on the other codes on the same claim, so it's a claim-level number rather than a per-code one. Use the calculator for a locality-adjusted, sequestration-aware amount.

Modifier What it means Amount
-26/TC Professional/technical split Not payable
-50 Bilateral procedure Not payable
-80/81/82 Assistant surgeon (physician) (16%) $14.49 If documented
-AS Assistant at surgery (PA, NP, or CNS) (13.6%) $12.31 If documented
-62 Co-surgeons, each Not payable
-66 Team surgery Not payable

These apply standard MPFS percentages—assistant surgeon 16%, co-surgeon 62.5%, bilateral 150%—to the national non-facility amount above, and require both the RVU inputs and the applicable payment rule as evidence. They are derived here rather than read from a CMS column: check them against the current Medicare Claims Processing Manual before relying on them for payment. A row marked If documented carries the ordinary percentage, but this code's CMS indicator pays it only when supporting documentation of medical necessity is submitted—an unpaid claim without that documentation is not an underpayment.

Can you bill it with another code? Copy link

Enter a second CPT or HCPCS code billed on the same date of service. We'll check the current NCCI procedure-to-procedure edit between it and 99442.

See every current NCCI pair for 99442 →

Allowed amount, program payment, and patient share Copy link

These figures use the same national baseline, with different participation and payment assumptions.

Computed from the Q4 2024 CMS release

Medicare allowed amount

What Medicare recognizes as the full price for 99442 in the office (non-facility) setting. Every figure below derives from it.

$90.54
Medicare's share

80% of the allowed amount, before the ~2% sequestration cut.

$72.43
Patient coinsurance

The remaining 20%, once the annual Part B deductible is met. Medigap or Medicaid often covers it.

$18.11
Limiting charge

The ceiling a non-participating provider can bill a patient on an unassigned claim—109.25% of the allowed amount.

$98.91

National Q4 2024 figures at GPCI 1.000. Adjust for your locality and sequestration, or expand the explanations below for each figure in full.

Is $90.54 what a practice actually receives?

It's the national allowed amount—the starting point. Medicare pays 80% of it ($72.43) and the patient owes 20% coinsurance ($18.11). Sequestration trims Medicare's share by about 2%, your locality's GPCIs scale the total up or down, and the expected-payment calculator applies all three. What lands is practice revenue: staff, space, equipment and billing, not clinician take-home pay. The practice-expense RVU above is CMS's estimate of that overhead share.

Sources: Budget Control Act sequestration provisions; CMS Medicare Fee-for-Service payment guidance; CMS Geographic Practice Cost Index (GPCI) files; CMS Physician Fee Schedule overview (cms.gov).

What's the non-participating amount for 99442?

$86.01 in the office (non-facility) setting—95% of the $90.54 participating fee schedule amount above. A participating provider takes the fee schedule amount as payment in full on every claim. A non-participating provider is paid this reduced amount, but chooses claim by claim whether to accept assignment. See participating vs non-participating.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

What's the limiting charge for 99442?

$98.91 in the office (non-facility) setting—the ceiling on what a non-participating provider can bill the patient on an unassigned claim. That's 109.25% of the $90.54 amount above. The non-participating amount is 95% of the fee schedule rate ($86.01), and the statutory cap is 115% of that. See limiting charge.

Sources: CMS Physician Fee Schedule overview (cms.gov); CMS Medicare Fee-for-Service payment guidance.

Common payment questions Copy link

Why would a Medicare claim for 99442 be denied or paid less?

These come from CMS indicators on this page, not general billing advice.

Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.

History

Rate history by release Copy link

National non-facility amount for 99442 across quarterly releases. +18.9% increase since Q2 2020 · high $92.82 in Q1 2021

$93 $83 $73 $62 $52 Q2 2020 · $76.15 Q3 2020 · $76.15 (0.0%) Q4 2020 · $76.15 (0.0%) Q1 2021 · $92.82 (+21.9%) Q2 2021 · $92.82 (0.0%) Q3 2021 · $92.82 (0.0%) Q4 2021 · $92.82 (0.0%) Q1 2022 · $91.71 (-1.2%) Q2 2022 · $91.71 (0.0%) Q3 2022 · $91.71 (0.0%) Q4 2022 · $91.71 (0.0%) Q1 2023 · $90.82 (-1.0%) Q2 2023 · $90.82 (0.0%) Q3 2023 · $90.82 (0.0%) Q4 2023 · $90.82 (0.0%) Q1 2024 · $89.06 (-1.9%) Q1 2024 · $90.54 (+1.7%) Q2 2024 · $90.54 (0.0%) Q3 2024 · $90.54 (0.0%) Q4 2024 · $90.54 (0.0%) Q1 2013 Q2 2016 Q3 2018 Q3 2020 Q4 2022 Q4 2024
Non-facility Facility
Release Status Non-facility Facility
Q4 2024 Oct 1, 2024 – present A $90.54 (0.0% no change ) $64.91 (0.0% no change )

This price has been unchanged since Q1 2024, when it increased 1.7%.

When does this rate change?

CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.

The 99442 rate last moved in Q1 2024. See its rate history.

Sources: CMS Medicare Physician Fee Schedule Relative Value Files.

Beyond Medicare

Contracted rate: % of Medicare Copy link

Commercial payer contracts usually price off the Medicare amount above ("BCBS pays 115% of Medicare"). Enter your contract's percentage below to see what 99442 pays at that rate—$90.54 is 100%.

We want to build this: store your multipliers once, and every code page shows your rate instead of Medicare's. Tell us if you'd use it →

See how to find your contract's actual percentage.

Usage & related

How often 99442 is billed Copy link

Across Original Medicare in CY2024, 99442 ranked #182 of the 7,879 CPT codes billed to Medicare that year, by patients served or total allowed dollars. It repeats: a patient billed for it in 2024 was billed 1.5 times on average that year.

Beneficiaries
851,892
Office + facility patients combined
Services
1.3M
Times it was billed
Allowed
$107.5M
Total Medicare allowed dollars
Compare: ↑ #180 more popular · 76536 ↓ #184 less popular · 11103

2024 Medicare fee-for-service national totals. They exclude Medicare Advantage, Medicaid and commercial volume, so real-world use runs higher. This is a calendar-year snapshot from the CMS Physician & Other Practitioners dataset, on a different cycle from the Q4 2024 fee schedule above.

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Source & method

Show sources

This page uses CMS's Medicare Physician Fee Schedule Q4 2024 release (effective October 2024). National baselines use GPCI 1.000 and exclude sequestration. Status and payment instructions determine whether a national amount is established; blank RVUs stay blank. Releases are immutable: historical evidence remains tied to the specified release. Modifier amounts apply standard MPFS percentages to this code's billing indicators. We derive them here rather than read them from CMS, so confirm them against the current Claims Processing Manual before relying on them for payment. Our methodology covers the depth: sourcing, parsing, versioning, and how we cross-check claims before they ship.

Physician relative value file (Q4 2024) · rvu24d.zip (PPRRVU24_OCT.csv row 18,637)

Use the (i) buttons next to each amount above for the exact row, columns, and math.

Cite this rate

This citation identifies the source release, so its evidence remains reproducible after a newer release lands.

CPT 99442 National PFS baseline: Office (non-facility) $90.54; Facility $64.91 (Q4 2024; participating; whole service; GPCI 1.000; sequestration excluded). Localis. https://localishealth.com/cpt/99442/2024/D