CPT 99234 Fee Schedule

Last Verified: January 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.

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. (Desc Rvsd 1/1/23)

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	• None • 25 - Significant, separately identifiable E/M service same day • GC - Service performed by resident under supervision
Complexity Level	Low

National average reimbursement for CPT 99234 by major payers:

$146.83

$137.56

$140.29

$177.75

Preview provider-level rates for...

For billing codeCPT 99234

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 99234
United	99234	$214.08	1457707689 - ANDREW HAMMOUD	161395906 - (NY) UNITED MEDICAL ASSOCIATES PC	NY	Internal Medicine Physician (207R00000X)
United	99234	$216.36	1295186526 - SASSAN ANDALIBI	611661781	NY	Hospitalist Physician (208M00000X)
United	99234	$160.24	1013232545 - YUE YU	822790856 - (NY) DR SALIBS MEDICAL PRACTICE PC	NY	Internal Medicine Physician (207R00000X)
United	99234	$271.07	1740662592 - NAVEED CHOUDRY	461322238	MD	Internal Medicine Physician (207R00000X)
United	99234	$129.22	1861550782 - NAVEENA PATHMAKUMAR	132655001 - NEW YORK CITY HEALTH AND HOSPITALS CORPORATION	NY	Internal Medicine Physician (207R00000X)
United	99234	$209.91	1962866756 - KAMAL SINGH	141338544 - SAMARITAN HOSPITAL	NY	Internal Medicine Physician (207R00000X)
United	99234	$108.52	1235556325 - DEV SHAH	844439455	NY	Hospitalist Physician (208M00000X)
United	99234	$172.91	1780665661 - DONNA MILDVAN	133988963	NY	Internal Medicine Physician (207R00000X)
United	99234	$155.58	1790110955 - AMANDEEP SINGH	160743102 - OLEAN GENERAL HOSPITAL	NY	Internal Medicine Physician (207R00000X)
United	99234	$487.14	1720645534 - YUSRA QAISER	943342387	NY	Internal Medicine Physician (207R00000X)
United	99234	$96.83	1326083593 - DANUTA KURSTEIN	262153390	NY	Internal Medicine Physician (207R00000X)
United	99234	$138.44	1982635504 - JOHN FABIAN	161417246	NY	Internal Medicine Physician (207R00000X)
United	99234	$164.80	1255498325 - KALYANA KANAPARTHY	237221763 - THE UNITY HOSPITAL OF ROCHESTER	NY	Hospitalist Physician (208M00000X)
United	99234	$247.49	1144634221 - GARY WONG	61603195	NY	Hospitalist Physician (208M00000X)
United	99234	$108.52	1740396191 - GEORGE BERTERO	1740396191 - (NY) GEORGE BERTERO	NY	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 99234 vs. Other Hospital Inpatient and Observation Care Services Codes

The CPT 99234 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 99234 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)
99234-CPT	Low	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. (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 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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