CPT 99253
Global XXXIp/obs cnsltj new/est low 45
CPT 99253 Billing & Documentation Guide
CPT code 99253 (Ip/obs cnsltj new/est low 45) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2, a non-facility practice expense RVU of 0.84, and a malpractice RVU of 0.12, a total non-facility RVU of 2.96 and facility RVU of 2.96. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $100.88, though rates vary from $92.97 to $132.29 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99253, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99253 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Invalid for Medicare; not separately payable
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 0 units of 99253 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99253
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2 | 2 |
| Practice Expense RVU | 0.84 | 0.84 |
| Malpractice RVU | 0.12 | 0.12 |
| Total RVU | 2.96 | 2.96 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99253
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $104.57 | $104.57 | $100.84 - $116.76 | 29 |
| Florida | $102.76 | $102.76 | $99.65 - $106.15 | 3 |
| Georgia | $98.47 | $98.47 | $96.61 - $100.32 | 2 |
| Illinois | $101.81 | $101.81 | $98.68 - $104.67 | 4 |
| Michigan | $98.79 | $98.79 | $96.94 - $100.63 | 2 |
| North Carolina | $95.54 | $95.54 | $95.54 - $95.54 | 1 |
| New York | $106.72 | $106.72 | $96.27 - $111.88 | 5 |
| Ohio | $96.46 | $96.46 | $96.46 - $96.46 | 1 |
| Pennsylvania | $99.17 | $99.17 | $96.35 - $101.99 | 2 |
| Texas | $98.52 | $98.52 | $96.06 - $100.71 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99253
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99253 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0074T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 0115T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0116T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0365T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99253
What does CPT code 99253 mean? +
CPT code 99253 represents: Ip/obs cnsltj new/est low 45. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99253? +
The 2026 Medicare national average non-facility payment for CPT 99253 is $100.88. Rates range from $92.97 to $132.29 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99253? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99253? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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