CPT 99239 Fee Schedule
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.
| 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 • FS - Split/shared E/M visit |
| Complexity Level | Low |
National average reimbursement for CPT 99239 by major payers:
$138.27
$123.70
$120.28
$166.60
| 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 99239 | ||||||
United | 99239 | $184.63 | 1932130325 - ELIZABETH BERRY-KRAVIS | 911780120 - (IL) RUSH UNIVERSITY MEDICAL CENTER | IL | Neurology with Special Qualifications in Child Neurology Physician (2084N0402X) |
United | 99239 | $97.62 | 1730214206 - KALYANI GAVINI | 371158318 - (IL) SOUTHERN ILLINOIS HEALTHCARE FOUNDATION INC | MO | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99239 | $139.00 | 1063972404 - MAANASA BANDLA | 811324691 | VA | Child & Adolescent Psychiatry Physician (2084P0804X) |
United | 99239 | $156.25 | 1245670207 - MABEL AVILAS | 232983574 - (IL) UHS OF HARTGROVE INC | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $156.25 | 1699752204 - CATHERINE CAMILLERI | 581672987 - (IL) EDWARD HEALTH VENTURES | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $156.25 | 1073054326 - FRED JONES-ROSA | 223682760 | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $114.87 | 1275564197 - PAUL BERKOWITZ | 842494027 - BRIGHTSIDE MEDICAL | FL | Psychiatry Physician (2084P0800X) |
United | 99239 | $120.62 | 1033199336 - ANDREW PUNDY | 1033199336 - (IL) ANDREW PUNDY | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $327.70 | 1255457263 - ANNA VOELLER | 363261413 - ALLINA HEALTH SYSTEM | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $98.44 | 1285406512 - RACHEL JOHNSON | 363149833 - NORTHWESTERN MEMORIAL HEALTHCARE | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $114.87 | 1205917176 - RANDY JUNG | 371305510 - TOUCHETTE REGIONAL HOSPITAL INC | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $120.62 | 1518113786 - DEEP BUCH | 363454190 - (IL) PIYUSH C BUCH MDPC | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $161.36 | 1801813266 - GREGG BEAN | 741671142 - (TX) SOUTH TEXAS RADIOLOGY GROUP, P.A. | TX | Diagnostic Radiology Physician (2085R0202X) |
United | 99239 | $102.52 | 1235592494 - ERIKA STEINBRENNER | 872646229 - (IL) IMAGINE THERAPY MINDFULNESS HEALING PLLC | IL | Psychiatry Physician (2084P0800X) |
United | 99239 | $137.88 | 1073697132 - FEDRA NAJJAR | 376000511 - THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOIS | IL | Child & Adolescent Psychiatry Physician (2084P0804X) |
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 99239 vs. Other Hospital Inpatient and Observation Care Services Codes
The CPT 99239 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 99239 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) |
| 99239-CPT | Low | Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes On The Date Of The Encounter (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 99239. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99239 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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