CPT 99233 Fee Schedule
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.
| 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 • GC - Service performed by resident under supervision • FS - Split/shared E/M visit |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 99233 |
National average reimbursement for CPT 99233 by major payers:
$132.59
$120.63
$118.06
$165.81
| 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 99233 | ||||||
United | 99233 | $106.09 | 1407877046 - LUIS ARANGO | 742275163 - (TX) LUIS F. ARANGO, M.D., F.C.C.P., P.A . | TX | Internal Medicine Physician (207R00000X) |
United | 99233 | $183.45 | 1477655470 - HAR CHI LAU | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Surgery Physician (208600000X) |
United | 99233 | $138.56 | 1104125806 - SARAH PACHTMAN | 453023019 - NORTH SHORE-LIJ MEDICAL PC | NY | Maternal & Fetal Medicine Physician (207VM0101X) |
United | 99233 | $214.10 | 1710008966 - OLIVER GHALAMBOR | 811123403 - (TX) NOBILITY MEDICAL PLLC | TX | Internal Medicine Physician (207R00000X) |
United | 99233 | $151.85 | 1497311856 - KAITLYN SIMPSON | 61127657 - (NY) MIDDLETOWN MEDICAL PC | NY | Family Medicine Physician (207Q00000X) |
United | 99233 | $123.62 | 1578519740 - ELLIOTT FRIEDMAN | 61127657 - (NY) MIDDLETOWN MEDICAL PC | NY | Endocrinology, Diabetes & Metabolism Physician (207RE0101X) |
United | 99233 | $159.72 | 1205003480 - HELEN XENOS | 362169147 - ADVOCATE HEALTH AND HOSPITALS CORPORATION | IL | Family Medicine Physician (207Q00000X) |
United | 99233 | $176.00 | 1578958914 - DEBBIE GOODMAN | 611661781 | NY | Internal Medicine Physician (207R00000X) |
United | 99233 | $134.36 | 1497916837 - CYNTHIA QUAINOO | 113237480 - (NY) URBAN STRATEGIES-BROOKDALE FAMILY CARE CENTER INC | NY | Gastroenterology Physician (207RG0100X) |
United | 99233 | $153.99 | 1447224548 - CRAIG BRADY | 464534925 | AZ | Family Medicine Physician (207Q00000X) |
United | 99233 | $103.27 | 1770547630 - MICHAEL LI | 200306655 - (NY) MICHAEL LI, MD PLLC | NY | Gastroenterology Physician (207RG0100X) |
United | 99233 | $305.07 | 1851566095 - CARL CRAWFORD | 131623978 | NY | Gastroenterology Physician (207RG0100X) |
United | 99233 | $56.72 | 1497916837 - CYNTHIA QUAINOO | 474039553 | NY | Gastroenterology Physician (207RG0100X) |
United | 99233 | $84.47 | 1144669532 - CHRISTOPHER CHUM | 132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION | NY | Gastroenterology Physician (207RG0100X) |
United | 99233 | $139.58 | 1588982524 - JOHN WINTERS | 611661781 | NY | Infectious Disease Physician (207RI0200X) |
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 99233 vs. Other Hospital Inpatient and Observation Care Services Codes
The CPT 99233 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 99233 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) |
| 99233-CPT | High | 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. (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 99233. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99233 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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