CPT 99231 Fee Schedule

Last Verified: January 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.

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)

Key Fact	Detail
Service Type	• Evaluation and Management • Hospital Inpatient and Observation Care Services
Common Place of Service	• 21 - Inpatient Hospital • 51 - Inpatient Psychiatric Facility • 22 - On Campus Outpatient Hospital
Common Modifiers	• None • GC - Service performed by resident under supervision • 25 - Significant, separately identifiable E/M service same day
Complexity Level	Low
Medicare Fee Schedule	View Medicare rates for 99231

National average reimbursement for CPT 99231 by major payers:

$54.09

$48.81

$66.26

$66.79

Preview provider-level rates for...

For billing codeCPT 99231

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 99231
United	99231	$48.36	1255692752 - SHEIPHALI GANDHI	943281657	MN	Internal Medicine Physician (207R00000X)
United	99231	$68.90	1265450811 - HUSSIEN ELSIESY	752536818 - HEALTHTEXAS PROVIDER NETWORK	NY	Gastroenterology Physician (207RG0100X)
United	99231	$139.03	1063483907 - MARK SCHATTNER	133278574 - (NY) MEMORIAL GASTROENTEROLOGY GROUP	NY	Internal Medicine Physician (207R00000X)
United	99231	$45.11	1730616855 - MATTHEW JOSEPHSON	141556189 - (NY) SARATOGA-SCHENECTADY GASTROENTEROLOGY ASSOCS PC	NY	Gastroenterology Physician (207RG0100X)
United	99231	$76.63	1841463650 - NAGANATHAN MANI	430653611 - WASHINGTON UNIVERSITY	MO	Vascular & Interventional Radiology Physician (2085R0204X)
United	99231	$49.02	1467470328 - RICHARD FRIED	453023019 - (NY) NORTH SHORE-LIJ MEDICAL PC	NY	Gastroenterology Physician (207RG0100X)
United	99231	$34.97	1063894343 - EDDIE COPELIN	161503382 - (NY) DIGESTIVE DISEASE MEDICINE OF CNY, LLP	NY	Gastroenterology Physician (207RG0100X)
United	99231	$190.89	1255500153 - ROBIN MENDELSOHN	133278574 - (NY) MEMORIAL GASTROENTEROLOGY GROUP	NY	Gastroenterology Physician (207RG0100X)
United	99231	$39.18	1790777894 - LILY YEE	200740539 - (NY) THOMAS LYO MEDICAL PC	NY	Internal Medicine Physician (207R00000X)
United	99231	$57.93	1225291685 - DAVID LEE	135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK	NY	Gastroenterology Physician (207RG0100X)
United	99231	$51.15	1932469293 - JOSEPH CANO	752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS	TX	Gastroenterology Physician (207RG0100X)
United	99231	$43.61	1043269335 - PANKAJ GARG	201726439 - (NY) BROCKPORT INTERNAL MEDICINE PC	NY	Internal Medicine Physician (207R00000X)
United	99231	$38.83	1790771715 - RICHARD TAY	481058737 - (KS) PRATT REGIONAL MEDICAL CENTER CORPORATION	TX	Gastroenterology Physician (207RG0100X)
United	99231	$72.25	1396955233 - JESSICA SHAH	752005254 - TEXAS DIGESTIVE DISEASE CONSULTANTS	TX	Gastroenterology Physician (207RG0100X)
United	99231	$31.92	1366504284 - DARALYN SAMUELS	133864615 - (NY) THEODORE CDOCU MD PC	NY	Internal Medicine Physician (207R00000X)
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

Want to see your competitors' rates?

Start your trial today to unlock complete access to provider rates and fee schedules in your area.

Run a free sample report

Here's what you can do with PayerPrice

Renegotiate your managed care contracts

Benchmark your current rates against market averages to identify opportunities for rate optimization.

Prospect for new business using fee schedules

Access every provider's negotiated rates for every billing code in your market to inform your prospecting strategies.

Integrate real-time payer data into your workflows

Automatically keep fee schedules up-to-date without adding yet another log-in to your insurance systems. Connect via API or SQL.

Explore state-level rates for free

PayerPrice shows you the exact negotiated rates that insurers publish under federal transparency rules.
We display the raw data directly from insurers' files, giving you the same information they make public. Learn more about Price Transparency.

CPT 99231 vs. Other Hospital Inpatient and Observation Care Services Codes

The CPT 99231 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 99231 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 99231. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99231 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 99231) and we'll show you how you compare in 15 minutes or less.

Schedule a Demo