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See a sample rate comparisonCPT 99238 Fee Schedule
Last Verified: September 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 Discharge Day Managem, Hospital Discharge Day Management 30 Minutes Or Less(This Code Is To Be Utilized By The Physician To Report All Services Provided To A Patient On The Date Of Discharge
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Hospital Inpatient and Observation Care Services |
| Common Place of Service | 21 - Inpatient Hospital 22 - On Campus Outpatient Hospital 51 - Inpatient Psychiatric Facility |
| Common Modifiers | None GC - Service performed by resident under supervision 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | View Medicare rates for 99238 |
| Medicaid Fee Schedule | View Medicaid rates for 99238 |
National average reimbursement for CPT 99238 by major payers:
$98.03
$86.60
$88.61
$116.37
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CPT 99238
5 of 25 sample ratesHigher to lower in this preview
Schvon Cummings
Blessing Corporate Services Inc
$159.00Published rateAliya Hafeez
Advocate Health And Hospitals Corporation
$113.90Published rateRolando Gomez
Naples Womens Center LLC
$86.66Published rateMorris Blount
Grand Prairie Services
$85.04Published rateJason Mcmaster
Huron Memorial Hospital
$67.50Published rate
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See a sample payer proposalCPT 99238 vs. Other Hospital Inpatient and Observation Care Services Codes
The CPT 99238 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 99238 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 |
| 99222-CPT | Moderate | 1st Hosp Ip Obs Moderate 55, 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 |
| 99223-CPT | High | 1st Hosp Ip Obs High 75, 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 |
| 99238-CPT | Low | Hospital Discharge Day Managem, Hospital Discharge Day Management 30 Minutes Or Less(This Code Is To Be Utilized By The Physician To Report All Services Provided To A Patient On The Date Of Discharge |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99238. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99238 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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