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See a sample rate comparisonCPT 99236 Fee Schedule
Last Verified: September 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.
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 | None 25 - Significant, separately identifiable E/M service same day GC - Service performed by resident under supervision |
| Complexity Level | High |
| Medicare Fee Schedule | View Medicare rates for 99236 |
| Medicaid Fee Schedule | View Medicaid rates for 99236 |
National average reimbursement for CPT 99236 by major payers:
$270.89
$240.34
$239.24
$325.45
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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 CPT 99236 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 99236 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 |
| 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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