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 99232 Fee Schedule
Last Verified: October 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.
Sbsq Hosp Ip Obs Moderate 35, 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 Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 35 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 51 - Inpatient Psychiatric Facility 61 - Comprehensive Inpatient Rehab Facility |
| Common Modifiers | GC - Service performed by resident under supervision FS - Split/shared E/M visit |
| Complexity Level | Moderate |
| ASAM Level | Level 4 - Medically Managed Inpatient |
| Care Type | Treatment |
| Setting | Inpatient |
| Medicare Fee Schedule | $70.48 national non-facility rate (2026) · View Medicare rates for 99232 |
| Medicaid Fee Schedule | $57.00 median of the 8 states in the free preview · View Medicaid rates for 99232 |
National average reimbursement for CPT 99232 by major payers:
$89.94
$83.26
$87.19
$113.09
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99232.
CPT 99232
5 of 25 sample ratesHigher to lower in this preview
Mike Cheng
$377.19Published rateJennifer Watt
Barnabas Health Medical Group P C
$125.39Published rateKira Kiriakidi
The Unity Hospital Of Rochester
$89.48Published rateKenneth Fickling
The Unity Hospital Of Rochester
$70.44Published rateRay Ryan Santos
Drs Medical Associates LLC
$41.31Published 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 99232 vs. Other Hospital Inpatient and Observation Care Services Codes
The CPT 99232 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 99232 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 |
| 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 |
| 99232-CPT | Moderate | Sbsq Hosp Ip Obs Moderate 35, 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 Moderate Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 35 Minutes Must Be Met Or Exceeded |
| 99233-CPT | High | Sbsq Hosp Ip Obs High 50, 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 High Level Of Medical Decision Making When Using Total Time On The Date Of The Encounter For Code Selection 50 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 99232. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99232 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 99232) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To get an accurate estimate for a specific medical procedure or service, first obtain the Current Procedural Terminology (CPT) code from your healthcare provider. With this CPT code and your specific location, you can then use online tools like Payerprice. Payerprice offers a fee schedule lookup tool that allows you to search for typical costs, helping you understand potential out-of-pocket expenses and compare prices among different providers.
A CPT (Current Procedural Terminology) code is a standardized five-digit code used by healthcare providers to describe medical, surgical, and diagnostic services for billing and reimbursement purposes. These codes are crucial for price transparency because they ensure consistent communication about services rendered. Knowing the CPT code for a service allows you to search for pricing information more precisely, for example, by using a tool like Payerprice to compare costs.
No, health insurance typically does not cover 100% of all medical expenses. Most plans involve out-of-pocket costs such as deductibles (the amount you pay before your insurance starts covering costs), copayments (a fixed amount for a service), and coinsurance (a percentage of the cost after your deductible is met). Additionally, some services may not be covered at all or only partially, depending on your specific plan's benefits and whether the provider is in-network. Always review your insurance policy details and pre-authorize services when possible.
If you receive an unexpected or unusually high medical bill, first review it carefully for any errors and compare it with your Explanation of Benefits (EOB) from your insurance company. Next, contact your provider's billing department to clarify any discrepancies or questions. If the bill still seems incorrect or excessive, you can try to negotiate the price. For specific price comparisons based on CPT codes and your location, tools like Payerprice can help you determine if the charges are reasonable compared to market rates, providing valuable information for your discussions with the billing department.
Comparing healthcare service prices can be challenging due to cost variability. A crucial step is to obtain the specific CPT codes for the services you need from your provider. Once you have the CPT code and know your geographic location, you can effectively compare prices by using specialized online tools. Payerprice, for example, offers a fee schedule lookup tool where you can search with CPT codes and specific locations to find and compare typical costs from various providers in your area, enabling you to make more informed decisions.