Interprofessional Consultation Coding
Pexels: Christina Morillo
In today’s increasingly collaborative healthcare environment, interprofessional consultations play a vital role in delivering comprehensive, patient-centered care. Whether you’re a primary care physician seeking input from a specialist or a consulting provider offering expertise, understanding how to properly document and code these interactions is essential—not only for compliance but also for ensuring appropriate reimbursement.
This article provides a practical guide to interprofessional consultation coding, with a focus on CPT codes 99446–99449 and 99451–99452. We’ll explore documentation requirements, common use cases, and tips to help you navigate the nuances of coding in a way that supports both clinical collaboration and billing accuracy.
Interprofessional Consultation CPT Codes
| CPT | Description | Time Spent | Modality | Billing Provider |
|---|---|---|---|---|
| 99446 | Interprofessional telephone/Internet/electronic health record consultation | 5–10 minutes | Verbal + Written Report | Consulting Physician |
| 99447 | Same as above | 11–20 minutes | Verbal + Written Report | Consulting Physician |
| 99448 | Same as above | 21–30 minutes | Verbal + Written Report | Consulting Physician |
| 99449 | Same as above | 31+ minutes | Verbal + Written Report | Consulting Physician |
| 99451 | Interprofessional consultation via written report only | ≥5 minutes | Written Report Only | Consulting Physician |
| 99452 | Referral service provided by treating/requesting physician | ≥16 minutes | Coordination/Prep | Treating/Requesting Physician |
Code Restrictions
- An interprofessional consultation code should not be reported if the consulting provider has seen the patient in person within the past 14 days.
- Similarly, if the consultation leads to a face-to-face encounter (such as an inpatient visit), the interprofessional consultation code is not reportable.
These restrictions help ensure appropriate use of interprofessional consultation codes by distinguishing them from direct patient encounters. Always verify the timing and nature of services before reporting.
Case Example: Primary Care to Neurology Consultation
Scenario:
Dr. Smythe, a primary care physician, is managing a 68-year-old patient with new-onset tremors. She requests input from Dr. Lewis, a neurologist, to help determine whether the symptoms are consistent with Parkinson’s disease.
- Dr. Lewis reviews the patient’s chart, MRI results, and recent labs in the shared EHR.
- He spends 18 minutes reviewing the case and then calls Dr. Smythe to discuss his impressions and recommendations.
- He also documents a written summary of his findings in the EHR.
Coding:
- Dr. Lewis (neurologist) bills CPT 99447 for 11–20 minutes of consultative time with verbal and written communication.
- Dr. Smythe (PCP) may bill CPT 99452 if she spent at least 16 minutes preparing the case and coordinating care.
Documentation Requirements
Must include:
- Reason for consult (request)
- Informed consent (Medicare requirement)
- Summary of findings
- Time spent
- Communication with requesting provider
Note: Since the consulting physician is not seeing the patient, the requesting (treating) physician must obtain and document the informed consent.
Use G-Codes for (CMS) Behavioral Health Providers
CMS recognized that the existing CPT codes excluded many behavioral health providers due to E/M billing restrictions.
To address this:
- In 2025, CMS created G-codes to allow clinical psychologists, social workers, and other non-E/M billing providers to participate in and be reimbursed for interprofessional consultations
- These codes support mental health integration, especially in underserved areas and team-based care models
- They reflect CMS’s broader push to expand behavioral health access, reduce fragmentation, and promote value-based care
Comparison Codes CPT 99446–99449, 99451, 99452 HCPCS G0546–G0551 Audience Physicians & QHPs with E/M billing Behavioral health providers Time-based Yes Yes Verbal & Written Report Required (99446–99449) Required (G0546–G0549) Written Report Only 99451 G0550 Treating Provider Code 99452 G0551 Behavioral Health Focus No Yes Medicare Eligibility Limited Expanded
Summary
These consultative services enable specialist input without a face-to-face visit, enhancing care coordination and reducing unnecessary referrals. Compliance hinges on clear intent, appropriate timing, and thorough documentation.
Resources
AAOS Now – Interprofessional Consultations Coding
Coding Intel – Interprofessional Internet Consultations
MSHBC (Internal Link): Behavioral Health Interprofessional Consultations
Betsy Nicoletti (YouTube): Interprofessional Consultations
2025 AMA CPT: CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.