What is the difference between CPT 99222 and other Hospital Inpatient and Observation Care Services codes?

CPT 99222 is an Evaluation and Management (E&M) service code specifically for Hospital Inpatient and Observation Care. It represents a moderate-complexity encounter. The key differences between CPT 99222 and other codes in this service category are determined by the time spent by the provider, the complexity of medical decision-making (MDM), and the required documentation. CPT 99222 typically involves more provider time and a moderate level of medical decision-making, often encompassing multiple diagnoses, managing medications, or interpreting test results. Lower-level codes in this category, conversely, require less time and simpler assessments. This difference in complexity directly impacts the level of reimbursement and the detail required in documentation. For specific reimbursement details and fee schedules for CPT 99222 in your location, we recommend using Payerprice, which provides a fee schedule lookup tool to search with the CPT code and specific location.

CPT 99222 Fee Schedule

Last Verified: July 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

1st Hosp Ip Obs Moderate 55, 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 Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 55 Minutes Must Be Met Or Exceeded

Key Fact	Detail
Service Type	New or Established Patient Initial Hospital Inpatient or Observation Care
Common Place of Service	21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 51 - Inpatient Psychiatric Facility
Common Modifiers	None AI - Principal Physician of Record GC - Service performed by resident under supervision
Complexity Level	Moderate
ASAM Level	Level 4 — Medically Managed Inpatient
Care Type	Treatment
Setting	Inpatient
Medicare Fee Schedule	View Medicare rates for 99222

National average reimbursement for CPT 99222 by major payers:

$157.27

$126.59

$153.54

$201.47

Preview provider-level rates for...

For billing codeCPT 99222

Payer	Code	Rate	NPI	Tax ID	State	Specialty
United	99222	$305.75	1699967323 - NEETI MISRA	223376459 - HACKENSACK MERIDIAN HEALTH MEDICAL GROUP-SPECIALTY CARE PC	NJ	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$120.23	1821373945 - PROVIDENCE MEDICAL GROUP INC, PROVIDENCE SURGERY CENTER@ CORNERSTONE	421534506 - PROVIDENCE MEDICAL GROUP, INC.	OH	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$131.57	1922181494 - MONTGOMERY UROLOGY CLINIC	561457280	NC	Urology Physician (208800000X)
United	99222	$261.33	1598328916 - KATY REINES	834333066	NC	Urology Physician (208800000X)
United	99222	$248.60	1841358686 - DAVID MARKOWITZ	133957095 - (NY) THE NEW YORK AND PRESBYTERIAN HOSPITAL	NY	Gastroenterology Physician (207RG0100X)
United	99222	$214.66	1487150074 - PAIGE HAMILTON	272528143	NC	Urology Physician (208800000X)
United	99222	$89.25	1851377394 - SAM MOSKOWITZ	20707730 - (NY) SAM MOSKOWITZ, M.D., P.C.	NY	Gastroenterology Physician (207RG0100X)
United	99222	$204.92	1063440055 - WARREN OVERBEY	561398929	NC	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$288.08	1174644314 - ERNEST MCPHAIL	581728803	NC	Urology Physician (208800000X)
United	99222	$185.83	1598860850 - MICHAEL PATRIARCO	831933437 - STAR COMMUNITY HEALTH INC	PA	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$267.51	1578158622 - NOVANT HEALTH MEDICAL GROUP COASTAL REGION, LLC, NHMGCR ATLANTIC UROLOGY	861441258	NC	Urology Physician (208800000X)
United	99222	$240.67	1386667194 - RICHARD VISCI	341933718 - NORTHERN OHIO MEDICAL SPECIALISTS, LLC	OH	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$187.69	1790177574 - RAFAEL MARQUEZ	831933437 - STAR COMMUNITY HEALTH INC	PA	Obstetrics & Gynecology Physician (207V00000X)
United	99222	$214.66	1326054859 - MARK JALKUT	272528143	NC	Urology Physician (208800000X)
United	99222	$264.17	1316943798 - KAREN SMITH	272777455	MA	Obstetrics & Gynecology Physician (207V00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99222 vs. Other Initial Hospital Inpatient or Observation Care Codes

The CPT 99222 code is part of the New or Established Patient services used for Initial Hospital Inpatient or Observation Care. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The CPT 99222 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

Code	Complexity	Description
99221-CPT	Low	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
99222-CPT	Moderate	1st Hosp Ip Obs Moderate 55, 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 Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 55 Minutes Must Be Met Or Exceeded
99223-CPT	High	1st 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
99231-CPT	Low	Sbsq 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

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99222. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99222 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules

Medicare & Medicaid Rates

Government-set reimbursement amounts

Private Insurance Rates

Negotiated rates between providers and insurance companies

Geographic Location

Costs may be higher in urban areas.

Provider Type

Hospital providers may have different rates than private practice.

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