What does Interprofessional Consultations pay in 2026?
| Code | What it covers | CY2026 national non-facility |
|---|---|---|
| 99446 | consult with verbal + written report, 5–10 min | $19.04 |
| 99447 | consult with verbal + written report, 11–20 min | $38.08 |
| 99448 | consult with verbal + written report, 21–30 min | $56.78 |
| 99449 | consult with verbal + written report, 31+ min | $76.15 |
| 99451 | consult, written report only, 5+ min | $35.40 |
| 99452 | requesting/referring practitioner's time, 30 min | $37.07 |
| G0546 | BH-clinician consult, 5–10 min | $19.04 |
| G0547 | BH-clinician consult, 11–20 min | $37.74 |
| G0548 | BH-clinician consult, 21–30 min | $56.78 |
| G0549 | BH-clinician consult, 31+ min | $76.49 |
| G0550 | BH-clinician consult, written report, 5+ min | $35.07 |
| G0551 | BH-clinician referral, 30 min | $36.74 |
National averages from our verified CY2026 fee-schedule config (source: CMS Physician Fee Schedule). Actual payment varies by locality, payer, and site of service.
Who can bill it?
The consulted specialist bills the time-tiered codes; the requesting practitioner bills 99452 (or G0551) for their side. The G-code lane (G0546–G0551, CY2025) lets behavioral-health clinicians — psychologists, LCSWs, counselors, MFTs — bill consultations directly.
This is practitioner time on both sides — no delegated staff minutes.
Event-based: each consultation episode bills once per side, tied to its documentation and time tier.
How do the time tiers work?
- The consultant's code follows the time spent: 5–10, 11–20, 21–30, or 31+ minutes of review and discussion.
- 99451/G0550 covers written-report-only consults of 5+ minutes; 99446–99449 require verbal and written reports.
- The requesting practitioner's own coordination time bills 99452/G0551 — 30 minutes of preparing and acting on the consult.
- Time tiers are per consultation episode, not per month.
What has to be in place first?
- Patient consent, obtained by the REQUESTING practitioner
- CMS places the verbal-consent duty — including disclosure of cost-sharing — on the treating practitioner who requests the consult. The consulting side carries no consent duty and shouldn't be gated on one.
- Real documentation on both sides
- The consultant's report (verbal and/or written per the code) and the requester's record of the request and its use.
- The right lane for the clinician
- E/M-eligible practitioners use 99446–99452; behavioral-health clinicians use the G0546–G0551 crosswalks.
What gets claims denied?
- Consent documented on the wrong side
- The requesting practitioner documents the patient's verbal consent before billing. A consultant's claim doesn't need it — but a requester's claim without it isn't payable.
- Unverified facility rates
- Every consult code's facility-setting value now comes straight from the CMS national relative value file (RVU26C) — facility payment runs meaningfully below the office rate for these codes, so a facility-based service must be priced on the facility value, not the office one.
- Assuming code parity
- 99451 and G0550 are NOT valued identically, and neither are the other apparent pairs — each code derives from its own published RVU. Bill the code for the clinician and work, not the 'equivalent'.
- Medicare-first G-codes on commercial payers
- The G0546–G0551 lane (CY2025) may not be loaded by commercial payers yet — CO-181-class denials until adoption.
What could this look like for your panel?
Estimates only, not billing advice. Actual Medicare reimbursement varies by region, payer, and year. Figures approximate CY2026 national non-facility averages from our verified fee-schedule config.
Frequently asked questions
- Who gets the patient's consent for an interprofessional consult?
- The requesting (treating) practitioner — verbal consent, documented, including that cost-sharing may apply. CMS deliberately did not put this duty on the consulting side.
- Can a psychologist or LCSW bill for giving a consult?
- Yes — the CY2025 G-code lane (G0546–G0551) crosswalks the consultation codes to behavioral-health clinicians, who bill them directly.
- Does the patient need to be present?
- No — the entire point is practitioner-to-practitioner advice without moving the patient. It is not a telehealth service; it's a consultation service.
- What would an 'unverified estimate' flag mean?
- Our fee schedule flags any figure not confirmed against a CMS primary source and refuses to export a claim priced from one. As of the August 2026 verification pass every published rate here is confirmed against the CMS relative value file, so no code currently carries the flag — but the mechanism stays armed for future code changes.
This page is general information, not billing, coding, or legal advice. Verify current requirements with the relevant payer before billing. Mallowa helps practices capture and document coordination time and generates claim-ready superbills; it does not submit claims or determine eligibility.