Hospitalist reimbursement
by service line
Compare commercial hospitalist rates for initial, subsequent, observation, discharge, critical care, and prolonged inpatient services.
Compare national hospitalist rates by payer
Compare national payer rates for common inpatient encounters and see how reimbursement changes across the hospital stay.
Aetna state variation for 99233
National 99233 rate distribution
Each marker shows the national average published rate across billing entities for that payer.
National 99233 rates by payer
| Payer | Rate period | Provider entities | P25 | Median | P75 | P90 | Average |
|---|---|---|---|---|---|---|---|
| Aetna | Q2 2026 | 42,810 | $146.71 | ||||
| Cigna | Q2 2026 | 952 | $361.21 | ||||
| United | Q2 2026 | 62,313 | $183.95 |
- Source
- Negotiated rates published directly by payers in their machine-readable files.
- Rate shown
- Published commercial rate for subsequent hospital care, high level (99233).
- Method
- Eligible rates are grouped by payer and billing entity so the benchmarks use a consistent service and billing basis.
The state map uses one consistent Aetna reference series; it does not average already-aggregated payer values. The service-line table keeps unlike codes, settings, and billing units in separate comparisons.
How do specific hospitalist providers compare?
Compare named provider rates with the selected payer's median and percentile distribution.
Hospitalist provider rates by payer
| Provider entity | State | Size | $ per service | Gap to median | Position in Aetna range |
|---|
Named provider examples are available in a scoped hospitalist market comparison.
Choose one state to replace the mixed-state examples with payer-specific provider rates across all three preview codes.
No trial or data preparation required.How reimbursement changes across hospitalist services
Keep initial, subsequent, observation, discharge, critical care, prolonged, and advance care planning services in their own encounter and time context.
| Service line / billing code | Nat'l avg | Aetna | Cigna | United | Anthem |
|---|---|---|---|---|---|
$ per service · 3 codes | |||||
99221Initial hospital or observation care, low complexity | $136.29 | — | |||
99222Initial hospital or observation care, moderate complexity | $181.67 | — | |||
99223Initial hospital or observation care, high complexity | $251.87 | — | |||
$ per service · 3 codes | |||||
99231Subsequent hospital or observation care, low complexity | $72.15 | — | |||
99232Subsequent hospital or observation care, moderate complexity | $104.41 | — | |||
99233Subsequent hospital or observation care, high complexity | $146.71 | — | |||
$ per service · 3 codes | |||||
99234Same-day hospital admission and discharge, low complexity | $164.92 | — | |||
99235Same-day hospital admission and discharge, moderate complexity | $222.11 | — | |||
99236Same-day hospital admission and discharge, high complexity | $291.08 | — | |||
$ per service · 2 codes | |||||
99238Hospital discharge management, 30 minutes or less | $106.33 | — | |||
99239Hospital discharge management, more than 30 minutes | $146.43 | — | |||
$ per service · 5 codes | |||||
99291Critical care, first 30–74 minutes | $392.99 | — | |||
99292Critical care, each additional 30 minutes | $188.41 | — | |||
99418Prolonged inpatient or observation care, each additional 15 minutes | $57.29 | — | |||
99497Advance care planning, first 30 minutes | $121.45 | — | |||
99498Advance care planning, each additional 30 minutes | $120.17 | — | |||
Tell us the services, payers, states, and networks you need. We'll confirm available coverage and scope the comparison on a 20-minute call.
Book a 20-min scoping call No trial or data preparation required.How these hospitalist rates are calculated
We start with negotiated rates published in payer machine-readable files and included in the underlying professional hospitalist report. For each selected billing code, eligible records are grouped by payer and summarized as averages and percentile distributions.
- Rate sourceThe displayed amount is a negotiated professional hospitalist rate published in a payer machine-readable file, not a paid claim, billed charge, or hospital facility payment.
- CalculationNational values summarize eligible published records across available states. State views use records associated with the selected state, and averages are not weighted by inpatient volume, length of stay, or acuity.
- Provider entityNamed examples use payer-file NPI and TIN records and may represent a hospitalist group, staffing organization, health system, or other billing entity.
- Comparable ratesMatch the encounter type, service level, time threshold, professional billing context, payer product, and network. Hospital facility reimbursement remains separate.
Get the hospitalist reimbursement data you're looking for
Choose the services, payers, states, networks, and provider entities relevant to your question. We'll confirm the available coverage and prepare the comparison.
- Tell us your marketShare the specialty, geography, payers, networks, and providers.
- We find comparable ratesPayerPrice aligns billing codes, services, settings, and units.
- Get your market viewSee relevant payer and provider rates organized around your question.
We'll tell you what the data can support, where the gaps are, and the clearest way to structure the comparison.
Trusted by teams that need defensible reimbursement data
How to interpret hospitalist rates
How to interpret the selected market and payer-published rates.
Which hospitalist services are included?
The report covers initial and subsequent hospital care, observation care, discharge management, critical care, prolonged services, and advance care planning.
Why are initial and subsequent care separated?
They describe different encounters and levels of work, so each code should be benchmarked against the same service.
Do these rates include the hospital facility payment?
No. These are professional negotiated rates associated with hospitalist services.
How should observation, discharge, and time-based services be compared?
Use the exact encounter and time code. Observation, same-day admission and discharge, discharge management, critical care, and prolonged services represent different work and should remain separate.
How are named hospitalist providers selected?
The public table selects billing entities across each payer's published rate range. An entity may represent a hospitalist group, staffing organization, health system, or other contracted billing organization.