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See a sample rate comparisonCPT 99238 Fee Schedule
Medicare rates as of October 2026
CPT 99238 is classified under Evaluation and Management, in the Hospital Inpatient and Observation Care Services subgroup.
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 | GC - Service performed by resident under supervision 25 - Significant, separately identifiable E/M service same day |
| Complexity Level | Low |
| Medicare Fee Schedule | $74.82 national non-facility rate (2026) · View Medicare rates for 99238 |
| Medicaid Fee Schedule | $61.535 median of the 8 states in the free preview · View Medicaid rates for 99238 |
National average reimbursement for CPT 99238 by major payers:
$98.03
BCBS / Anthem
$86.60
UnitedHealthcare
$88.61
Aetna
$116.37
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99238.
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 table lists codes related to 99238. 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 |
| 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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Frequently Asked Questions
CPT 99238 reports hospital inpatient or observation discharge day management of 30 minutes or less on the date of the encounter. More than 30 minutes uses 99239.
Total time on the discharge date counts, including the final exam, discussing the stay, instructions to caregivers, preparing discharge records and prescriptions, and referral forms.
Medicare pays CPT 99238 under the Physician Fee Schedule. The non-facility rate applies when the service is done in an office and covers the practice's staff, supplies and equipment; the lower facility rate applies in a hospital or surgery center, which bills its own facility fee. Both are adjusted for the local cost of practice. Commercial payers negotiate their own rates, often as a percentage of Medicare, so the same code can pay very differently from one contract to the next.
This page lists the rates commercial payers have published for CPT 99238 in their Transparency in Coverage files, so you can compare payers and see where a contract falls. For government benchmarks, PayerPrice also has the Medicare fee schedule lookup and Medicaid fee schedules by state.