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See a sample rate comparisonCPT 99222 Fee Schedule
Medicare rates as of October 2026
CPT 99222 is classified under Evaluation and Management, in the Hospital Inpatient and Observation Care Services subgroup.
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 | Evaluation and Management Hospital Inpatient and Observation Care Services |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 51 - Inpatient Psychiatric Facility |
| Common Modifiers | 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 | $116.90 national non-facility rate (2026) · View Medicare rates for 99222 |
| Medicaid Fee Schedule | $95.86 median of the 8 states in the free preview · View Medicaid rates for 99222 |
National average reimbursement for CPT 99222 by major payers:
$157.27
BCBS / Anthem
$126.59
UnitedHealthcare
$153.54
Aetna
$201.47
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99222.
CPT 99222
5 of 25 sample ratesHigher to lower in this preview
Seth Gendler
$313.64Published rateColton Walker
$273.39Published ratePaige Hamilton
$214.66Published rateAndrew Talal
Academic Medicine Services Inc
$142.75Published rateSam Moskowitz
Sam Moskowitz, M.D., P.C.
$89.25Published rate
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See a sample payer proposalCPT 99222 vs. Other Hospital Inpatient and Observation Care Services Codes
The table lists codes related to 99222. Select one to see its fee schedule.
| 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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Frequently Asked Questions
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.