CPT 99223 Fee Schedule

Last Verified: January 2026

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

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. (Desc Rvsd 1/1/23)

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	• None • AI - Principal Physician of Record • 25 - Significant, separately identifiable E/M service same day
Complexity Level	High

National average reimbursement for CPT 99223 by major payers:

$219.33

$175.84

$214.84

$280.93

Preview provider-level rates for...

For billing codeCPT 99223

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99223
United	99223	$214.77	1891780490 - MARC LAUFE	921919591 - (FL) PRECISION HEALTHCARE SPECIALISTS LLC	FL	Pulmonary Disease Physician (207RP1001X)
United	99223	$344.55	1770696197 - ROBERT CHATALBASH	453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC	NY	Gastroenterology Physician (207RG0100X)
United	99223	$179.00	1164767802 - NURIA STEINBERG	274602380 - (FL) VENTRE MEDICAL ASSOCIATES LLC	FL	Clinical Social Worker (1041C0700X)
United	99223	$212.50	1073578753 - AMJAD AWAN	812059478	TX	Gastroenterology Physician (207RG0100X)
United	99223	$195.74	1134170640 - MUHAMMAD HASAN	451861648	NY	Gastroenterology Physician (207RG0100X)
United	99223	$139.08	1255433744 - KATHIE BRAND	851223208 - (NY) PRIMARY PARTNERCARE PHYSICIANS, PLLC	NY	Internal Medicine Physician (207R00000X)
United	99223	$292.08	1376548032 - ANNAMARIA PATELLI	851223208 - (NY) PRIMARY PARTNERCARE PHYSICIANS, PLLC	NY	Internal Medicine Physician (207R00000X)
United	99223	$214.77	1194773069 - ADAM RIKER	921919591 - (FL) PRECISION HEALTHCARE SPECIALISTS LLC	LA	Surgical Oncology Physician (2086X0206X)
United	99223	$449.95	1790075828 - DHVANI SHAH	862109896 - DUKE HEALTH INTEGRATED PRACTICE INC	NY	Gastroenterology Physician (207RG0100X)
United	99223	$145.69	1205928603 - VICENTA CACERES	1205928603 - (NY) VICENTA CACERES	NY	Gastroenterology Physician (207RG0100X)
United	99223	$162.77	1407829955 - QAISRA SAEED	270317604 - (NJ) QAISRA SAEED LLC	NJ	Cardiovascular Disease Physician (207RC0000X)
United	99223	$468.77	1790865012 - ARTHUR MAGUN	135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NY	Gastroenterology Physician (207RG0100X)
United	99223	$127.69	1265436174 - JOHN BOOZAN	223583998 - (NJ) JOHN M BOOZAN MD PA	NJ	Ophthalmology Physician (207W00000X)
United	99223	$214.77	1235181553 - TODD LINDQUIST	921919591 - (FL) PRECISION HEALTHCARE SPECIALISTS LLC	FL	Otolaryngology Physician (207Y00000X)
United	99223	$159.80	1558521674 - ALISA FEMIA	132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	NY	Dermatology Physician (207N00000X)
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 99223 vs. Other Hospital Inpatient and Observation Care Services Codes

The CPT 99223 code is part of the Evaluation and Management services used for Hospital Inpatient and Observation Care Services. 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 99223 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	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. (Desc Rvsd 1/1/23)
99222-CPT	Moderate	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. (Desc Rvsd 1/1/23)
99223-CPT	High	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. (Desc Rvsd 1/1/23)
99231-CPT	Low	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. (Desc Rvsd 1/1/23)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99223. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99223 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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