CPT 99232 Fee Schedule
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.
| Key Fact | Detail |
|---|---|
| Service Type | Subsequent Hospital Inpatient or Observation Care Hospital Inpatient and Observation Care Services |
| Common Place of Service | 21 - Inpatient Hospital 51 - Inpatient Psychiatric Facility 61 - Comprehensive Inpatient Rehab Facility |
| Common Modifiers | None 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 | View Medicare rates for 99232 |
National average reimbursement for CPT 99232 by major payers:
$89.94
$83.26
$87.19
$113.09
| Payer | Code | Rate | NPI | Tax ID | State | Specialty |
|---|---|---|---|---|---|---|
United | 99232 | $377.19 | 1144679846 - MIKE CHENG | 943281657 | CA | Internal Medicine Physician (207R00000X) |
United | 99232 | $129.93 | 1023641859 - JENNIFER WATT | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Physical Medicine & Rehabilitation Physician (208100000X) |
United | 99232 | $125.39 | 1023641859 - JENNIFER WATT | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Physical Medicine & Rehabilitation Physician (208100000X) |
United | 99232 | $97.71 | 1629140033 - JAY ADLERSBERG | 112419534 - (NY) NORTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C. | NY | Rheumatology Physician (207RR0500X) |
United | 99232 | $70.44 | 1649265539 - AJAI NEMANI | 160743134 - ROCHESTER GENERAL HOSPITAL | NY | Interventional Pain Medicine Physician (208VP0014X) |
United | 99232 | $89.48 | 1275793440 - KIRA KIRIAKIDI | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | Family Medicine Physician (207Q00000X) |
United | 99232 | $263.58 | 1962580019 - SWARNPAL SEKHON | 824780648 | CA | Internal Medicine Physician (207R00000X) |
United | 99232 | $126.34 | 1962780288 - POOJA SAREEN | 264709927 - WESTCHESTER MEDICAL CENTER ADVANCED PHYSICIAN SERVICES, P.C | NY | Hospitalist Physician (208M00000X) |
United | 99232 | $320.25 | 1730318916 - DOMINIKA SEIDMAN | 943281660 | IL | Obstetrics & Gynecology Physician (207V00000X) |
United | 99232 | $53.50 | 1437318730 - WAEL ELDARAWY | 271946555 - FAMILY GASTRO, PC | NY | Gastroenterology Physician (207RG0100X) |
United | 99232 | $129.93 | 1023641859 - JENNIFER WATT | 223316007 - BARNABAS HEALTH MEDICAL GROUP P C | NJ | Physical Medicine & Rehabilitation Physician (208100000X) |
United | 99232 | $70.44 | 1508855347 - KENNETH FICKLING | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | Anesthesiology Physician (207L00000X) |
United | 99232 | $89.48 | 1356373716 - TERRANCE OWENS | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | Emergency Medicine Physician (207P00000X) |
United | 99232 | $97.71 | 1043424542 - DAVID ASKIN | 112419534 - (NY) NORTH SHORE HEMATOLOGY-ONCOLOGY ASSOCIATES, P.C. | NY | Hematology & Oncology Physician (207RH0003X) |
United | 99232 | $41.31 | 1821241381 - RAY RYAN SANTOS | 473612001 - (NJ) DRS MEDICAL ASSOCIATES LLC | NJ | 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 |
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CPT 99232 vs. Other Hospital Inpatient and Observation Care Services Codes
The CPT 99232 code is part of the Subsequent Hospital Inpatient or Observation Care 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 |
| 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 |
| 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 |
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.
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