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See a sample rate comparisonCPT 99234 Fee Schedule
Medicare rates as of October 2026
CPT 99234 is classified under Evaluation and Management, in the Hospital Inpatient and Observation Care Services subgroup.
Hosp Ip Obs Sm Dt Sf Low 45, Hospital Inpatient Or Observation Care For The Evaluation And Management Of A Patient Including Admission And Discharge On The Same Date 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 45 Minutes Must Be Met Or Exceeded
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Hospital Inpatient and Observation Care Services |
| Common Place of Service | 22 - On Campus Outpatient Hospital 21 - Inpatient Hospital |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | Low |
| Medicare Fee Schedule | $88.18 national non-facility rate (2026) · View Medicare rates for 99234 |
| Medicaid Fee Schedule | $77.765 median of the 8 states in the free preview · View Medicaid rates for 99234 |
National average reimbursement for CPT 99234 by major payers:
$146.83
BCBS / Anthem
$137.56
UnitedHealthcare
$140.29
Aetna
$179.81
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99234.
CPT 99234
5 of 25 sample ratesHigher to lower in this preview
Yusra Qaiser
$487.14Published rateAndrew Hammoud
United Medical Associates PC
$214.08Published rateKalyana Kanaparthy
The Unity Hospital Of Rochester
$164.80Published rateJulia Cherkasova
New York City Health And Hospitals Corporation
$109.02Published rateSeth Mensah
Clifton Springs Sanitarium Co
$89.08Published rate
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See a sample payer proposalCPT 99234 vs. Other Hospital Inpatient and Observation Care Services Codes
The table lists codes related to 99234. Select one to see its fee schedule.
| 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 |
| 99234-CPT | Low | Hosp Ip Obs Sm Dt Sf Low 45, Hospital Inpatient Or Observation Care For The Evaluation And Management Of A Patient Including Admission And Discharge On The Same Date 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 45 Minutes Must Be Met Or Exceeded |
| 99235-CPT | Moderate | Observation Care, Observation Or Inpatient Hospital Care For The Evaluation And Management Of A Patient Including Admission And Discharge On The Same Date Which Requires These 3 Key Components: A Comprehensive History; A Comprehensive Examination; And Medical Decision Making Of Moderate Complexity. Counseling And/Or Coordination Of Care With Other Physicians Other Qualified Health Care Professionals Or Agencies Are Provided Consistent With The Nature Of The Problem(S) |
| 99236-CPT | High | Hosp Ip Obs Same Date Hi 85, Hospital Inpatient Or Observation Care For The Evaluation And Management Of A Patient Including Admission And Discharge On The Same Date 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 85 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 99234. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99234 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. CPT codes are standardized five-digit alphanumeric codes used by medical professionals and facilities to describe medical, surgical, and diagnostic services provided to patients. They are essential for billing, processing insurance claims, and determining the cost of specific procedures and services.
To find the cost of a specific medical procedure, you'll typically need its CPT code and your geographic location. Various price transparency tools and resources are available. For accurate and specific pricing information, especially for self-pay or out-of-network costs, it is recommended to use a specialized tool like Payerprice. Payerprice offers a fee schedule lookup tool where you can search with a CPT code and your specific location to get detailed pricing information. Always confirm pricing directly with your healthcare provider and, if applicable, your insurance company, as final costs can vary based on individual circumstances and insurance coverage.
A fee schedule in healthcare is a comprehensive list of fees used by health insurers, government programs (like Medicare), or healthcare providers themselves to determine the maximum dollar amount that will be paid or charged for a covered healthcare service or procedure. It specifies the negotiated rates for CPT codes. Understanding fee schedules can help patients anticipate costs and compare prices. Tools like Payerprice provide access to fee schedule information to help consumers understand potential costs.
Billed charges are the initial prices that healthcare providers set for their services, which are often significantly higher than what is actually paid. The allowed amount, also known as the 'allowable charge' or 'negotiated rate,' is the maximum amount your insurance plan will pay for a covered healthcare service. The difference between these two is often a result of contract negotiations between the provider and the insurer. Your out-of-pocket costs (such as deductibles, copayments, and coinsurance) are typically based on the allowed amount, not the billed charge.
Payerprice is a valuable resource designed to bring transparency to healthcare costs. Its fee schedule lookup tool allows users to search for specific CPT codes and locations to find pricing information for various medical procedures and services. This capability can help you compare costs across different providers, estimate potential out-of-pocket expenses, and make more informed decisions about your healthcare, especially if you are uninsured, have a high-deductible insurance plan, or are considering out-of-network care. It empowers you to research costs before receiving services.