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See a sample rate comparisonCPT 99233 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.
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
| 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 | GC - Service performed by resident under supervision FS - Split/shared E/M visit |
| Complexity Level | High |
| ASAM Level | Level 4 - Medically Managed Inpatient |
| Care Type | Treatment |
| Setting | Inpatient |
| Medicare Fee Schedule | $106.88 national non-facility rate (2026) · View Medicare rates for 99233 |
| Medicaid Fee Schedule | $86.47 median of the 8 states in the free preview · View Medicaid rates for 99233 |
National average reimbursement for CPT 99233 by major payers:
$132.59
$120.63
$118.06
$165.96
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CPT 99233
5 of 25 sample ratesHigher to lower in this preview
Rajiv Sharma
North Shore-Lij Medical PC
$648.91Published rateDebbie Goodman
$176.00Published rateBikramjit Singh
Middletown Medical PC
$151.85Published rateJay Doshi
Middletown Medical PC
$123.62Published rateCynthia Quainoo
$56.72Published rate
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See a sample payer proposalCPT 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 | 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 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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Frequently Asked Questions
CPT stands for Current Procedural Terminology. These are a set of codes used by healthcare providers to describe medical, surgical, and diagnostic services to payers for reimbursement. Each CPT code represents a specific service or procedure and is essential for medical billing.
To understand the potential cost of a specific medical procedure or service based on a CPT code and your location, you can utilize tools designed for this purpose. Payerprice offers a fee schedule lookup tool that allows you to search with a CPT code and your specific location to find relevant pricing data, which can help you estimate costs.
A medical fee schedule is a comprehensive list of fees used by insurance companies to pay healthcare providers for specific medical procedures and services. These schedules define the maximum amount an insurer will pay for each CPT code, and they can vary significantly by payer, location, and type of service.
Medical costs can vary widely due to several factors, including the specific healthcare provider or facility, geographical location, the patient's insurance plan and its negotiated rates, the complexity of the case, and whether the provider is in-network or out-of-network. Different payers also have different fee schedules, contributing to price variations.
To understand your specific insurance coverage and out-of-pocket costs for a particular service, it's best to directly contact your insurance provider. They can provide details based on your specific plan, deductible, copayments, and coinsurance. For general pricing insights based on CPT codes and location, you can also refer to Payerprice's fee schedule lookup tool.
If you believe a medical bill is too high, first review it carefully for any errors. Then, contact the billing department of the healthcare provider to request an itemized bill and discuss your concerns. You should also contact your insurance company to understand what they covered and why. For insights into typical pricing for the services listed on your bill, you can use Payerprice's fee schedule lookup tool by entering the CPT codes and your location to compare costs.