CPT 99236 Fee Schedule
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.
| 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 |
National average reimbursement for CPT 99236 by major payers:
$270.89
$240.34
$239.24
$323.88
| 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 99236 | ||||||
United | 99236 | $176.25 | 1912194069 - STUART REIBER | 133807455 - (NY) STUART REIBER MD PC | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $671.85 | 1033408505 - ALICIA FLOYD | 920754820 | MN | Hospitalist Physician (208M00000X) |
United | 99236 | $246.39 | 1619387735 - USMAN AKHTAR | 832369572 - (CO) ROCKY MOUNTAIN HEALTHCARE PARTNERS PLLC | UT | Hospitalist Physician (208M00000X) |
United | 99236 | $1255.60 | 1477842201 - JOY VICTOR | 943281662 | CA | Internal Medicine Physician (207R00000X) |
United | 99236 | $250.05 | 1114506854 - MIA NISHIKAWA | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Hospitalist Physician (208M00000X) |
United | 99236 | $268.88 | 1588939821 - JUDAH WEINSTEIN | 923137107 - MEDICAL SERVICES OF NASSAU PC | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $269.01 | 1598372443 - CHENGU NIU | 237221763 - THE UNITY HOSPITAL OF ROCHESTER | NY | Hospitalist Physician (208M00000X) |
United | 99236 | $221.58 | 1033552096 - NIKHIL SEVAL | 231352630 - DREXEL UNIVERSITY | CT | Internal Medicine Physician (207R00000X) |
United | 99236 | $235.11 | 1942209176 - SUCHARITA MEHTA | 113237480 - (NY) URBAN STRATEGIES-BROOKDALE FAMILY CARE CENTER INC | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $349.85 | 1003340068 - JOE JOSEPH | 272545213 - (MA) NEW ENGLAND COMMUNITY MEDICAL SERVICES, PLLC | MA | Internal Medicine Physician (207R00000X) |
United | 99236 | $320.60 | 1528421112 - SARAH SCHECHTER | 135598093 - COLUMBIA UNIVERSITY IN THE CITY OF NEW YORK | NY | Hospitalist Physician (208M00000X) |
United | 99236 | $388.51 | 1811981194 - GARY GUERRINO | 26407697 | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $230.72 | 1376503383 - GEORGE MALEGIANNAKIS | 275405975 | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $177.27 | 1033216387 - ADAH OBEKPA | 471472576 - (NY) IHOTU MEDICINE PC | NY | Internal Medicine Physician (207R00000X) |
United | 99236 | $292.29 | 1538573779 - BETTINA MANDUCA | 113492255 | 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 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 | 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) |
| 99236-CPT | High | 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. (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 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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