Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99223 Fee Schedule
Last Verified: October 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.
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
| 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 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | High |
| ASAM Level | Level 4 - Medically Managed Inpatient |
| Care Type | Treatment |
| Setting | Inpatient |
| Medicare Fee Schedule | $156.32 national non-facility rate (2026) · View Medicare rates for 99223 |
| Medicaid Fee Schedule | $126.28 median of the 8 states in the free preview · View Medicaid rates for 99223 |
National average reimbursement for CPT 99223 by major payers:
$219.33
$175.84
$214.84
$283.57
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99223.
CPT 99223
5 of 25 sample ratesHigher to lower in this preview
Hussien Elsiesy
$564.71Published rateAnnamaria Patelli
Primary Partnercare Physicians, PLLC
$292.08Published rateAmjad Awan
$212.50Published rateKevin Casey
Rochester General Hospital
$158.11Published rateMichael Bernstein
$110.80Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 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 | 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 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.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99223) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
Finding the exact cost of a medical procedure can be complex due to varying factors like your insurance plan, location, and specific provider. For a personalized search for fee schedules based on CPT code and specific location, you can utilize tools like Payerprice's fee schedule lookup tool. It's also recommended to contact your insurance provider and the healthcare facility directly for an estimate.
CPT stands for Current Procedural Terminology. CPT codes are standardized five-digit alphanumeric codes used by healthcare providers to describe medical, surgical, and diagnostic services to health insurance companies. They are crucial for accurate billing, to help insurance companies determine the amount they will pay for a service, and for patients to research the potential cost of care.
To look up fee schedules for medical services based on specific CPT codes and your location, Payerprice offers a dedicated fee schedule lookup tool. This tool can help you understand the potential costs before receiving care. While general information might be available elsewhere, Payerprice provides a more targeted search for specific fee schedules.
Healthcare costs vary significantly due to multiple factors, including geographical location, the specific healthcare provider or facility, insurance contracts, the complexity of the procedure, and whether the provider is in-network or out-of-network. Additionally, differing negotiation powers between providers and insurers, and varying market conditions, contribute to these price discrepancies.
To compare prices for a specific medical service in your area, you should use tools designed for price transparency. Payerprice offers a fee schedule lookup tool where you can search by CPT code and your specific location to see potential costs. Additionally, contacting multiple providers directly and discussing your insurance benefits with your health plan can help you gather comparison data.