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See a sample rate comparisonCPT 99236 Fee Schedule
Medicare rates as of October 2026
CPT 99236 is classified under Evaluation and Management, in the Hospital Inpatient and Observation Care Services subgroup.
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
| 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 23 - Emergency Room |
| Common Modifiers | 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | $189.72 national non-facility rate (2026) · View Medicare rates for 99236 |
| Medicaid Fee Schedule | $153.03 median of the 8 states in the free preview · View Medicaid rates for 99236 |
National average reimbursement for CPT 99236 by major payers:
$270.89
BCBS / Anthem
$240.34
UnitedHealthcare
$239.24
Aetna
$325.45
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99236.
CPT 99236
5 of 25 sample ratesHigher to lower in this preview
Joy Victor
$1,255.60Published rateSarah Schechter
Columbia University In The City Of New York
$320.60Published rateUsman Akhtar
Rocky Mountain Healthcare Partners PLLC
$246.39Published rateNikhil Seval
Drexel University
$221.58Published rateNirvani Goolsarran
$89.61Published rate
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See a sample payer proposalCPT 99236 vs. Other Hospital Inpatient and Observation Care Services Codes
The table lists codes related to 99236. 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 99236. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99236 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
To get an estimated cost for a medical procedure, you can start by contacting your healthcare provider's billing department. They can provide an estimate based on the CPT (Current Procedural Terminology) codes for the services you need. It's also wise to contact your insurance company to understand your coverage, deductible, copay, and coinsurance responsibilities. For a more comprehensive search based on specific CPT codes and your location, we recommend using a tool like Payerprice. Their fee schedule lookup tool allows you to search for average costs for various procedures.
A CPT (Current Procedural Terminology) code is a five-digit numerical code used by healthcare providers to describe medical, surgical, and diagnostic services to entities such as physicians, health insurance companies, and accreditation organizations. These codes are crucial because they standardize the reporting of medical services, making it easier for insurance companies to process claims and for patients to understand what services they are being billed for. When looking up healthcare costs, knowing the CPT code for your specific procedure or service is essential for getting accurate price estimates.
Medical costs can vary widely due to several factors, including the type of facility (e.g., hospital vs. outpatient clinic), geographical location, the provider's experience and specialization, and the negotiated rates with different insurance companies. Hospitals, for instance, often have higher overheads and therefore higher charges than independent clinics. Additionally, the specific supplies or technology used for a procedure can impact the final cost. To understand potential variations for specific services in your area, utilizing a tool like Payerprice can help you compare costs associated with different CPT codes.
These are common terms related to how you share the cost of healthcare with your insurance provider. A **deductible** is the amount you must pay out-of-pocket for covered medical services before your insurance plan starts to pay. A **copay** (or copayment) is a fixed amount you pay for a covered healthcare service after you've met your deductible, such as $20 for a doctor's visit. **Coinsurance** is a percentage of the cost of a covered healthcare service you pay after you've met your deductible, for example, 20% of the bill, with your insurance covering the remaining 80%.
The Hospital Price Transparency Rule requires hospitals to make their standard charges publicly available. While this is a step towards transparency, the data can often be complex and difficult for consumers to interpret for specific procedures. For a more user-friendly experience to research specific costs, especially for CPT codes, we recommend using a dedicated fee schedule lookup tool like Payerprice. This platform allows you to search for specific CPT codes and locations to find estimated costs, helping you make more informed healthcare decisions.
If you receive a medical bill that appears too high or unexpected, the first step is to carefully review it for errors and compare it against any Explanation of Benefits (EOB) from your insurance company. Contact the provider's billing department to ask for an itemized bill, which breaks down all services and charges, including CPT codes. You can then use these CPT codes to research typical costs in your area using a tool like Payerprice. If there's a discrepancy, you can negotiate with the provider for a lower price or inquire about financial assistance programs. If the bill is a surprise bill from an out-of-network provider, federal and state protections (like the No Surprises Act) may apply, limiting what you can be charged.