CMS October 2026Physician Fee Schedule · Free lookup

CPT 99221 Medicare Fee Schedule 2026

Medicare's 2026 national payment for CPT 99221 is $74.48 in a non-facility setting ($74.48 in a facility), down 6.4% from $79.57 in 2025.

National rate, October 2026

Non-facility: $74.48
Facility: $74.48
vs. 2025: -6.4%
Commercial national avg.: $114.41

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HCPCS Codes

99221

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Year

20262025

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Physician Fee Schedule·99221·National·2026, 2025

Current non-facility rate

$74.48▲0.0%

Facility: $74.48

Recent trend

Code description

1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded

Code	Date	State	Non-Facility Fee	Facility Fee	Description
99221	10/2026	N/A	$74.48	$74.48	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	7/2026	N/A	$74.48	$74.48	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	4/2026	N/A	$74.48	$74.48	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	1/2026	N/A	$74.48	$74.48	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	10/2025	N/A	$79.57	$79.57	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	7/2025	N/A	$79.57	$79.57	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	4/2025	N/A	$79.57	$79.57	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded
99221	1/2025	N/A	$79.57	$79.57	1st Hosp Ip Obs Sf Low 40, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 40 Minutes Must Be Met Or Exceeded

99221 national rate by year

Each row is the latest CMS file published that year. Change is against the year before.

CMS file	Non-facility	Facility	Change
October 2026	$74.48	$74.48	-6.4%
October 2025	$79.57	$79.57	-2.8%
March 2024	$81.89	$81.89	-1.8%
January 2023	$83.36	$83.36	-17.2%
July 2022	$100.70	$100.70	-

This is the national amount before geographic adjustment. Medicare multiplies each relative value unit by its locality's geographic practice cost index, so a practice's own allowed amount can be higher or lower; pick a state above to see its localities. The facility amount applies when the service is performed in a hospital or other facility setting.

99221: Medicare vs. commercial national average

The commercial national average for 99221, the mean of what BCBS, UnitedHealthcare, Aetna and Cigna publish nationwide, is $114.41, 154% of Medicare's $74.48.

BCBS $109.43
UnitedHealthcare $86.74
Aetna $123.42
Cigna $138.06

A national average, not a local rate: each payer's figure averages the unmodified, in-network professional rates it publishes for 99221 across the country in its transparency files. Contracted rates vary widely by market, provider and plan. Medicare's figure is its national non-facility amount before geographic adjustment.

See commercial rates in your market Commercial rates for 99221

Nearby codes

99213 Medicare rate 99214 Medicare rate 99215 Medicare rate 99222 Medicare rate 99223 Medicare rate 99231 Medicare rate

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Medicaid comparison

See what state Medicaid programs pay for 99221

50 state Medicaid agencies publish their own physician fee schedule. The 99221 page shows real published rates for several of them free, with effective dates and official sources.

17,674 codes and 974,327 published rates, taken from the files the state agencies publish themselves.

See Medicaid rates for 99221

$116.90

992231st Hosp Ip Obs High 75, Initial Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 75 Minutes Must Be Met Or Exceeded

$156.32

99231Sbsq Hosp Ip Obs Sf Low 25, Subsequent Hospital Inpatient Or Observation Care Per Day For The Evaluation And Management Of A Patient Which Requires A Medically Appropriate History And Or Examination And Straightforward Or Low Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 25 Minutes Must Be Met Or Exceeded

$44.09

Methodology

Rates are sourced directly from CMS Physician Fee Schedule files, indexed quarterly. Non-facility and facility prices are calculated using the published GPCI for each locality and the year's conversion factor.

View CMS Physician Fee Schedule