Understanding 99255 RVU


The Relative Value Unit (RVU) is a crucial aspect of medical billing, and the 99255 RVU is no exception. In this article, we will delve into the intricacies of the 99255 RVU, its importance in the healthcare industry, and how it impacts medical practitioners and patients alike. 

What is 99255 RVU? 

The 99255 RVU refers to a specific code used in the medical billing process. This code is associated with the highest level of inpatient consultation services provided by a healthcare professional. The RVU attached to this code is a measure of the relative resources required to provide the service. 

Understanding the 99255 RVU is essential for healthcare providers as it directly impacts their reimbursement. It is also important for patients to have an understanding of this code, as it can affect their medical bills and insurance claims. 

The Role of RVU in Medical Billing 

RVU, or Relative Value Unit, is a standard measure used in the United States healthcare system to determine the value of a medical service. It takes into account the time, skill, and intensity required to perform a specific medical procedure or service. 

The RVU is a critical component of the Resource-Based Relative Value Scale (RBRVS), which is used by Medicare and other insurance companies to determine reimbursement rates for medical services. The higher the RVU, the higher the reimbursement rate. 

Components of RVU 

An RVU consists of three components: the Physician Work RVU, the Practice Expense RVU, and the Malpractice RVU. Each of these components plays a crucial role in determining the total RVU for a specific medical service. 

The Physician Work RVU reflects the time, skill, and intensity required to provide a service. The Practice Expense RVU covers the costs associated with maintaining a practice, including rent, equipment, and staff salaries. The Malpractice RVU accounts for the cost of professional liability insurance. 

Understanding the 99255 Code 

The 99255 code is used for the most complex inpatient consultations. These consultations require a comprehensive history and examination, and the physician typically spends 110 minutes at the bedside and on the patient's hospital floor or unit. 

The 99255 code is part of the Current Procedural Terminology (CPT), a set of codes developed by the American Medical Association to standardize medical communication across different healthcare providers and insurance companies. 

How to Use the 99255 Code 

The 99255 code should be used when a healthcare provider performs an inpatient consultation that meets specific criteria. These criteria include a comprehensive history and examination, and a high complexity of medical decision-making. 

It's important to note that the 99255 code should only be used for the first consultation visit on a given date. For additional visits on the same date, a different CPT code should be used. 

Impact of 99255 RVU on Healthcare Providers and Patients 

The 99255 RVU has a significant impact on both healthcare providers and patients. For healthcare providers, understanding and correctly using the 99255 RVU can directly affect their reimbursement rates. 

For patients, the 99255 RVU can impact their medical bills. A higher RVU can lead to higher costs for medical services. However, it's important to note that insurance companies often negotiate rates with healthcare providers, so the actual cost to the patient may vary. 

99255 RVU and Insurance Claims 

When a healthcare provider submits an insurance claim using the 99255 code, the insurance company uses the associated RVU to determine the reimbursement rate. Therefore, it's crucial for healthcare providers to accurately document and code their services to ensure they receive the appropriate reimbursement. 

For patients, understanding the 99255 RVU can help them better understand their medical bills and insurance claims. It can also help them advocate for themselves in discussions with healthcare providers and insurance companies. 


The 99255 RVU is a complex but essential aspect of the healthcare industry. It plays a significant role in medical billing and insurance claims, impacting both healthcare providers and patients. 

By understanding the 99255 RVU, healthcare providers can ensure they receive appropriate reimbursement for their services. Patients, on the other hand, can gain a better understanding of their medical bills and advocate for themselves in discussions with healthcare providers and insurance companies. 

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