Blue Cross Blue Shield Hospital Medicine
Compare Blue Cross Blue Shield's contracted rates for hospital medicine services against national averages and other major payers. Use these benchmarks to identify underpaid codes, prepare for contract renegotiations, and validate your reimbursement strategy.
BCBS rates vary substantially across the 30+ independent BCBS plans nationwide. State-by-state market dynamics and local provider negotiation drive significant pricing differences within the same specialty.
Introduction
Hospital medicine reimbursement is built on inpatient E&M codes stratified by visit complexity (initial, subsequent, and discharge), critical care time-based billing, and bedside procedure fees. Hospitalist groups are the primary billing providers for inpatient professional services at most U.S. hospitals, making E&M rate benchmarking a direct driver of group revenue.
Hospitalist contracts often include productivity-based compensation tied to wRVU targets, where the per-unit reimbursement from commercial payers directly affects group economics. Understanding how your payer mix and per-code reimbursement compares to national averages is essential for contract renegotiation and staffing model decisions.
Inpatient Evaluation & Management
Initial Hospital Care
First-day inpatient E&M visits for newly admitted patients. Initial hospital care codes carry the highest E&M reimbursement and require documentation of comprehensive history, exam, and medical decision-making.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99221 | 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) | 0120 | Room & board - semi-private | — |
| 99222 | 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) | 0120 | Room & board - semi-private | — |
| 99223 | 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) | 0120 | Room & board - semi-private | — |
Subsequent Hospital Care
Daily rounding visits for hospitalized patients. Subsequent care codes are the highest-volume billing codes for hospitalist groups and represent the majority of inpatient professional revenue.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99231 | Subsequent 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 Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 25 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) | 0120 | Room & board - semi-private | — |
| 99232 | Subsequent 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 35 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) | 0120 | Room & board - semi-private | — |
| 99233 | Subsequent 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 50 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) | 0120 | Room & board - semi-private | — |
Discharge Day Management
Discharge day services including care coordination, medication reconciliation, and discharge planning. Discharge codes are billed on the final day of an inpatient stay and are time-stratified.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99238 | Hospital Inpatient Or Observation Discharge Day Management; 30 Minutes Or Less On The Date Of The Encounter (Desc Rvsd 1/1/23) | 0120 | Room & board - semi-private | — |
| 99239 | Hospital Inpatient Or Observation Discharge Day Management; More Than 30 Minutes On The Date Of The Encounter (Desc Rvsd 1/1/23) | 0120 | Room & board - semi-private | — |
Observation Care
Same-Day Admission & Discharge
Observation or inpatient care services that begin and end on the same calendar date. Following the 2023 CMS code consolidation, multi-day observation patients are billed using the standard inpatient E&M codes (99221–99223 initial, 99231–99233 subsequent); only same-day stays retain dedicated observation codes.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99234 | 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 Straightforward Or Low Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 45 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) | 0762 | Observation room | — |
| 99235 | 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 Moderate Level Of Medical Decision Making. When Using Total Time On The Date Of The Encounter For Code Selection 70 Minutes Must Be Met Or Exceeded. (Desc Rvsd 1/1/23) | 0762 | Observation room | — |
| 99236 | 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) | 0762 | Observation room | — |
Critical Care
Critical Care Services
Time-based critical care billing for management of critically ill inpatients. Many hospitalist groups provide ICU coverage, and critical care codes carry the highest per-encounter reimbursement in hospital medicine.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99291 | Citical Care, Evaluation And Management Of The Unstable Critically Ill Or Unstable Critically Injured Patient, Requiring The Constant Attendance Of The Physician; Ist Hour | 0681 | Trauma response - critical care | — |
| 99292 | Critical Care, Evaluation And Management Of The Critically Ill Or Critically Injured Patient; Each Additional 30 Minutes (List Separately In Addition To Code For Primary Service) | 0681 | Trauma response - critical care | — |
Transitions of Care
Transitional Care Management
Post-discharge transitional care management services for patients transitioning from inpatient to outpatient settings. TCM codes require a communication within 2 business days of discharge and a face-to-face visit within 7 or 14 days.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 99495 | Transitional Care Management Services With The Following Required Elements: Communication (Directcontact Telephone Electronic) With The Patient And/Or Caregiver Within 2 Business Days Of Discharge At Least Moderate Level Of Medical Decision Making During The Service Period Face-To-Face Visit Within 14 Calendar Days Of Discharge (Desc Rvsd 1/1/23) | 0510 | Clinic | — |
| 99496 | Transitional Care Management Services With The Following Required Elements: Communication (Directcontact Telephone Electronic) With The Patient And/Or Caregiver Within 2 Business Days Of Discharge High Level Of Medical Decision Making During The Service Period Face-To-Face Visit Within 7 Calendar Days Of Discharge (Desc Rvsd 1/1/23) | 0510 | Clinic | — |
Hospitalist Bedside Procedures
Common Inpatient Procedures
Bedside procedures commonly performed by hospitalists including vascular access, fluid drainage, and joint aspiration. Procedural billing supplements E&M revenue and is an increasingly important component of hospitalist group productivity.
| Billing Code | Description | Revenue Code | Description | Avg. National BCBS Rate |
|---|---|---|---|---|
| 36556 | Insertion Of Non-Tunneled Centrally Inserted Central Venous Catheter; Age 5 Years Or Older | 0120 | Room & board - semi-private | — |
| 36620 | Catheterizat Artery Percutaneous | 0120 | Room & board - semi-private | — |
| 49083 | Once Per Dos Abdominal Paracentesis (Diagnostic Or Therapeutic); W/Imaging Guidance | 0120 | Room & board - semi-private | — |
| 32554 | Thoracentesis, Needle Or Catheter, Aspiration Of The Pleural Space; Without Imaging Guidance | 0120 | Room & board - semi-private | — |
What is a fee schedule?
A fee schedule is a list of negotiated prices that healthcare providers charge for specific services. These prices vary by payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the applicable fee schedule helps providers optimize billing for accurate reimbursement and helps patients anticipate out-of-pocket costs.
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.
View hospital medicine fee schedules for other major payers
What is Price Transparency?
The federal Price Transparency Rule took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). This landmark regulation mandates that insurance companies make healthcare costs transparent to the public. Read more here.
PayerPrice gives you access to the actual prices that insurers are legally required to publish under the Price Transparency Rule. We deliver this data exactly as reported in the insurers' machine-readable files, giving you an accurate view of negotiated rates. While insurers occasionally report incomplete or inaccurate data, our platform ensures you see the same information that insurers have made publicly available.
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