{"procedure":{"code_type":"CPT","code":"99255","lay_name":"Hospital specialist consultation, high-complexity visit","blurb":"A first consultation by a specialist for a patient who is admitted or under observation, at the highest level, involving a problem of high complexity and an extended period of physician time and decision-making.","slug":"cpt-99255-hospital-specialist-consultation-high-complexity-visit","description":"IP/Obs Consltj New/Est Pt High Mdm 80 Minutes","name_source":"llm:claude-opus-5","name_reviewed":false,"ccs":{"code":"227","label":"Consultation, evaluation, and preventative care","surgery_flag":"n/a"}},"settings":{"outpatient":{"setting":"outpatient","computed_at":"2026-09-25T11:55:12.319193Z","corpus_loaded_through":"2026-09-25T01:10:45.071082Z","filing_date_min":"2024-01-01","filing_date_max":"2026-09-22","checked_from":"2026-09-05T02:07:09.005325Z","checked_through":"2026-09-25T01:13:17.894377Z","n_priced_setters":3956,"n_filed":701,"n_usable":642,"n_not_usable":0,"n_labelled":14,"n_no_cash":45,"n_estimated":0,"n_states":49,"cash_p10":138.0,"cash_p20":211.2,"cash_p25":231.7,"cash_p50":344.73,"cash_p75":495.0,"cash_p80":533.65,"cash_p90":661.44,"cash_mean_trimmed":356.93,"gross_p50":521.0,"cash_to_gross_p50":0.7,"medicare_rate":null,"medicare_schedule":null,"medicare_year":null,"cash_to_medicare_p50":null,"by_state":[{"state":"AK","n":9,"p20":null,"p50":null,"p80":null},{"state":"AL","n":6,"p20":null,"p50":null,"p80":null},{"state":"AR","n":5,"p20":null,"p50":null,"p80":null},{"state":"AZ","n":5,"p20":null,"p50":null,"p80":null},{"state":"CA","n":22,"p20":121.44,"p50":253.0,"p80":491.0},{"state":"CO","n":14,"p20":198.0,"p50":344.8,"p80":498.0},{"state":"CT","n":6,"p20":null,"p50":null,"p80":null},{"state":"FL","n":11,"p20":300.0,"p50":509.0,"p80":1103.7},{"state":"GA","n":16,"p20":192.74,"p50":265.8,"p80":419.25},{"state":"HI","n":8,"p20":null,"p50":null,"p80":null},{"state":"IA","n":36,"p20":324.0,"p50":365.6,"p80":460.32},{"state":"ID","n":3,"p20":null,"p50":null,"p80":null},{"state":"IL","n":38,"p20":259.5,"p50":374.5,"p80":627.9},{"state":"IN","n":24,"p20":118.5,"p50":186.6,"p80":441.0},{"state":"KS","n":18,"p20":236.25,"p50":281.45,"p80":371.48},{"state":"KY","n":13,"p20":134.75,"p50":238.8,"p80":279.0},{"state":"LA","n":3,"p20":null,"p50":null,"p80":null},{"state":"MA","n":3,"p20":null,"p50":null,"p80":null},{"state":"MD","n":3,"p20":null,"p50":null,"p80":null},{"state":"ME","n":20,"p20":126.63,"p50":450.0,"p80":693.75},{"state":"MI","n":39,"p20":215.5,"p50":270.0,"p80":341.0},{"state":"MN","n":34,"p20":320.25,"p50":417.16,"p80":704.88},{"state":"MO","n":23,"p20":200.0,"p50":286.0,"p80":368.05},{"state":"MS","n":6,"p20":null,"p50":null,"p80":null},{"state":"MT","n":14,"p20":219.2,"p50":295.2,"p80":500.0},{"state":"NC","n":5,"p20":null,"p50":null,"p80":null},{"state":"ND","n":3,"p20":null,"p50":null,"p80":null},{"state":"NE","n":12,"p20":332.1,"p50":367.08,"p80":492.0},{"state":"NH","n":8,"p20":null,"p50":null,"p80":null},{"state":"NJ","n":1,"p20":null,"p50":null,"p80":null},{"state":"NM","n":1,"p20":null,"p50":null,"p80":null},{"state":"NV","n":4,"p20":null,"p50":null,"p80":null},{"state":"NY","n":26,"p20":180.02,"p50":335.72,"p80":488.0},{"state":"OH","n":22,"p20":220.85,"p50":427.89,"p80":648.0},{"state":"OK","n":15,"p20":231.7,"p50":231.7,"p80":363.35},{"state":"OR","n":8,"p20":null,"p50":null,"p80":null},{"state":"PA","n":22,"p20":125.81,"p50":163.62,"p80":378.0},{"state":"RI","n":2,"p20":null,"p50":null,"p80":null},{"state":"SC","n":7,"p20":null,"p50":null,"p80":null},{"state":"SD","n":3,"p20":null,"p50":null,"p80":null},{"state":"TN","n":11,"p20":106.5,"p50":148.19,"p80":151.54},{"state":"TX","n":22,"p20":251.0,"p50":370.16,"p80":498.4},{"state":"UT","n":2,"p20":null,"p50":null,"p80":null},{"state":"VA","n":6,"p20":null,"p50":null,"p80":null},{"state":"VT","n":11,"p20":297.0,"p50":420.0,"p80":617.61},{"state":"WA","n":18,"p20":303.16,"p50":387.6,"p80":577.0},{"state":"WI","n":34,"p20":402.08,"p50":533.65,"p80":800.1},{"state":"WV","n":14,"p20":191.0,"p50":208.0,"p80":332.8},{"state":"WY","n":6,"p20":null,"p50":null,"p80":null}],"by_segment":{"hospital_type":[{"key":"acute","n":353,"p20":183.3,"p50":311.96,"p80":506.95},{"key":"childrens","n":19,"p20":null,"p50":null,"p80":null},{"key":"critical_access","n":269,"p20":231.0,"p50":378.0,"p80":563.0}],"ownership":[{"key":"for_profit","n":37,"p20":134.75,"p50":238.8,"p80":445.0},{"key":"government","n":170,"p20":223.0,"p50":348.0,"p80":509.0},{"key":"nonprofit","n":434,"p20":214.86,"p50":355.0,"p80":536.0}],"affiliation":[{"key":"affiliated","n":439,"p20":197.5,"p50":344.8,"p80":533.65},{"key":"independent","n":203,"p20":223.0,"p50":342.51,"p80":536.0}]},"histogram":[{"lo":106.5,"hi":130.3,"n":23},{"lo":130.3,"hi":159.41,"n":27},{"lo":159.41,"hi":195.02,"n":33},{"lo":195.02,"hi":238.6,"n":58},{"lo":238.6,"hi":291.91,"n":77},{"lo":291.91,"hi":357.13,"n":86},{"lo":357.13,"hi":436.92,"n":108},{"lo":436.92,"hi":534.55,"n":86},{"lo":534.55,"hi":653.98,"n":49},{"lo":653.98,"hi":800.1,"n":35}],"previous":null},"inpatient":{"setting":"inpatient","computed_at":"2026-09-25T11:55:12.319193Z","corpus_loaded_through":"2026-09-25T01:10:45.071082Z","filing_date_min":"2024-01-01","filing_date_max":"2026-09-22","checked_from":"2026-09-05T02:07:09.005325Z","checked_through":"2026-09-25T01:13:17.894377Z","n_priced_setters":3956,"n_filed":432,"n_usable":395,"n_not_usable":0,"n_labelled":2,"n_no_cash":35,"n_estimated":0,"n_states":47,"cash_p10":148.19,"cash_p20":214.13,"cash_p25":231.7,"cash_p50":351.4,"cash_p75":498.55,"cash_p80":520.0,"cash_p90":607.72,"cash_mean_trimmed":350.59,"gross_p50":516.0,"cash_to_gross_p50":0.65,"medicare_rate":null,"medicare_schedule":null,"medicare_year":null,"cash_to_medicare_p50":null,"by_state":[{"state":"AK","n":2,"p20":null,"p50":null,"p80":null},{"state":"AL","n":6,"p20":null,"p50":null,"p80":null},{"state":"AR","n":3,"p20":null,"p50":null,"p80":null},{"state":"CA","n":12,"p20":178.81,"p50":348.0,"p80":581.71},{"state":"CO","n":6,"p20":null,"p50":null,"p80":null},{"state":"CT","n":6,"p20":null,"p50":null,"p80":null},{"state":"FL","n":8,"p20":null,"p50":null,"p80":null},{"state":"GA","n":14,"p20":192.74,"p50":265.8,"p80":419.25},{"state":"HI","n":7,"p20":null,"p50":null,"p80":null},{"state":"IA","n":19,"p20":298.8,"p50":365.6,"p80":365.6},{"state":"ID","n":1,"p20":null,"p50":null,"p80":null},{"state":"IL","n":34,"p20":257.4,"p50":387.1,"p80":664.8},{"state":"IN","n":16,"p20":134.75,"p50":177.75,"p80":265.3},{"state":"KS","n":3,"p20":null,"p50":null,"p80":null},{"state":"KY","n":9,"p20":null,"p50":null,"p80":null},{"state":"LA","n":2,"p20":null,"p50":null,"p80":null},{"state":"MA","n":1,"p20":null,"p50":null,"p80":null},{"state":"MD","n":2,"p20":null,"p50":null,"p80":null},{"state":"ME","n":18,"p20":126.63,"p50":386.94,"p80":693.75},{"state":"MI","n":22,"p20":184.0,"p50":286.4,"p80":410.55},{"state":"MN","n":17,"p20":354.45,"p50":398.15,"p80":458.46},{"state":"MO","n":9,"p20":null,"p50":null,"p80":null},{"state":"MS","n":2,"p20":null,"p50":null,"p80":null},{"state":"MT","n":7,"p20":null,"p50":null,"p80":null},{"state":"NC","n":4,"p20":null,"p50":null,"p80":null},{"state":"ND","n":3,"p20":null,"p50":null,"p80":null},{"state":"NE","n":8,"p20":null,"p50":null,"p80":null},{"state":"NH","n":6,"p20":null,"p50":null,"p80":null},{"state":"NJ","n":1,"p20":null,"p50":null,"p80":null},{"state":"NV","n":3,"p20":null,"p50":null,"p80":null},{"state":"NY","n":15,"p20":236.25,"p50":385.0,"p80":499.0},{"state":"OH","n":14,"p20":113.4,"p50":223.0,"p80":516.11},{"state":"OK","n":11,"p20":231.7,"p50":231.7,"p80":231.7},{"state":"OR","n":6,"p20":null,"p50":null,"p80":null},{"state":"PA","n":12,"p20":169.25,"p50":337.4,"p80":473.9},{"state":"RI","n":2,"p20":null,"p50":null,"p80":null},{"state":"SC","n":5,"p20":null,"p50":null,"p80":null},{"state":"SD","n":2,"p20":null,"p50":null,"p80":null},{"state":"TN","n":9,"p20":null,"p50":null,"p80":null},{"state":"TX","n":18,"p20":341.0,"p50":370.16,"p80":563.0},{"state":"UT","n":2,"p20":null,"p50":null,"p80":null},{"state":"VA","n":5,"p20":null,"p50":null,"p80":null},{"state":"VT","n":8,"p20":null,"p50":null,"p80":null},{"state":"WA","n":7,"p20":null,"p50":null,"p80":null},{"state":"WI","n":21,"p20":533.65,"p50":533.65,"p80":800.1},{"state":"WV","n":6,"p20":null,"p50":null,"p80":null},{"state":"WY","n":1,"p20":null,"p50":null,"p80":null}],"by_segment":{"hospital_type":[{"key":"acute","n":244,"p20":192.74,"p50":333.3,"p80":495.0},{"key":"childrens","n":12,"p20":null,"p50":null,"p80":null},{"key":"critical_access","n":138,"p20":223.35,"p50":378.0,"p80":536.0}],"ownership":[{"key":"for_profit","n":31,"p20":134.75,"p50":217.25,"p80":333.3},{"key":"government","n":86,"p20":240.0,"p50":370.16,"p80":509.0},{"key":"nonprofit","n":277,"p20":225.0,"p50":365.6,"p80":533.65}],"affiliation":[{"key":"affiliated","n":286,"p20":217.25,"p50":365.6,"p80":520.0},{"key":"independent","n":109,"p20":210.0,"p50":319.2,"p80":531.96}]},"histogram":[{"lo":113.4,"hi":136.81,"n":18},{"lo":136.81,"hi":165.06,"n":12},{"lo":165.06,"hi":199.15,"n":21},{"lo":199.15,"hi":240.27,"n":44},{"lo":240.27,"hi":289.88,"n":39},{"lo":289.88,"hi":349.73,"n":44},{"lo":349.73,"hi":421.95,"n":67},{"lo":421.95,"hi":509.07,"n":43},{"lo":509.07,"hi":614.18,"n":51},{"lo":614.18,"hi":741.0,"n":18}],"previous":null}},"related":[{"code_type":"CPT","code":"99283","lay_name":"Emergency room visit, level 3 of 5","slug":"cpt-99283-emergency-room-visit-level-3-of-5"},{"code_type":"CPT","code":"99284","lay_name":"Emergency room visit, level 4 of 5","slug":"cpt-99284-emergency-room-visit-level-4-of-5"},{"code_type":"CPT","code":"99282","lay_name":"Emergency room visit, level 2 of 5","slug":"cpt-99282-emergency-room-visit-level-2-of-5"},{"code_type":"CPT","code":"99285","lay_name":"Emergency room visit, highest level","slug":"cpt-99285-emergency-room-visit-highest-level"},{"code_type":"CPT","code":"99281","lay_name":"Emergency room visit, lowest level","slug":"cpt-99281-emergency-room-visit-lowest-level"},{"code_type":"CPT","code":"99291","lay_name":"Critical care, first 30 to 74 minutes","slug":"cpt-99291-critical-care-first-30-to-74-minutes"},{"code_type":"CPT","code":"99292","lay_name":"Critical care, each additional 30 minutes","slug":"cpt-99292-critical-care-each-additional-30-minutes"},{"code_type":"CPT","code":"99211","lay_name":"Brief office visit for an existing patient (level 1)","slug":"cpt-99211-brief-office-visit-for-an-existing-patient-level-1"},{"code_type":"CPT","code":"99213","lay_name":"Office visit for an existing patient, moderate level","slug":"cpt-99213-office-visit-for-an-existing-patient-moderate-level"},{"code_type":"CPT","code":"99212","lay_name":"Short office visit for an existing patient","slug":"cpt-99212-short-office-visit-for-an-existing-patient"},{"code_type":"CPT","code":"99214","lay_name":"Office visit, established patient, moderate complexity","slug":"cpt-99214-office-visit-established-patient-moderate-complexity"},{"code_type":"CPT","code":"99215","lay_name":"Office visit, established patient, high complexity","slug":"cpt-99215-office-visit-established-patient-high-complexity"}]}