Cigna Hospital Medicine
Compare Cigna'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.
Cigna's commercial rates often follow a percentage-of-Medicare structure, with year-over-year adjustments tied to RBRVS updates and network-specific reimbursement multipliers.
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 Cigna Rate |
|---|---|---|---|---|
| 99221 | 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 | 0120 | Room & board - semi-private | $138.06 |
| 99222 | 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 | 0120 | Room & board - semi-private | $201.47 |
| 99223 | 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 | 0120 | Room & board - semi-private | $283.57 |
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 Cigna Rate |
|---|---|---|---|---|
| 99231 | Sbsq Hosp Ip Obs Sf Low 25, 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 | 0120 | Room & board - semi-private | $66.52 |
| 99232 | Sbsq Hosp Ip Obs Moderate 35, 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 | 0120 | Room & board - semi-private | $113.09 |
| 99233 | Sbsq Hosp Ip Obs High 50, 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 | 0120 | Room & board - semi-private | $165.96 |
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 Cigna Rate |
|---|---|---|---|---|
| 99238 | 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 | 0120 | Room & board - semi-private | $116.37 |
| 99239 | Hospital Discharge Day Managem, Hospital Discharge Day Management More Than 30 Minutes(This Code Is To Be Utilized By The Physicianto Report All Services Provided To A Patient On The Date Of Discharge If | 0120 | Room & board - semi-private | $166.94 |
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 Cigna Rate |
|---|---|---|---|---|
| 99234 | Hosp Ip Obs Sm Dt Sf Low 45, 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 | 0762 | Observation room | $179.81 |
| 99235 | Observation Care, Observation Or Inpatient Hospital Care For The Evaluation And Management Of A Patient Including Admission And Discharge On The Same Date Which Requires These 3 Key Components: A Comprehensive History; A Comprehensive Examination; And Medical Decision Making Of Moderate Complexity. Counseling And/Or Coordination Of Care With Other Physicians Other Qualified Health Care Professionals Or Agencies Are Provided Consistent With The Nature Of The Problem(S) | 0762 | Observation room | $253.04 |
| 99236 | Hosp Ip Obs Same Date Hi 85, 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 | 0762 | Observation room | $325.45 |
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 Cigna Rate |
|---|---|---|---|---|
| 99291 | Critical Care Evaluation And, Critical Care Evaluation And Management Of The Unstablecritically Ill Or Unstable Critically Injured Patient Requiring The Constant Attendance Of The Physician First | 0681 | Trauma response - critical care | $419.55 |
| 99292 | Critical Care Addl 30 Min, 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 | $186.16 |
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 Cigna Rate |
|---|---|---|---|---|
| 99495 | Care Management, Assessment Of And Care Planning For A Patient With Cognitive Impairment Requiring An Independent Historian In The Office Or Other Outpatient Home Or Domiciliary Or Rest Home With All Of The Following Required Elements: Cognition-Focused Evaluation Including A Pertinent History And Examination Medical Decision Making Of Moderate Or High Complexity Functional Assessment (Eg Basic And Instrumental Activities Of Daily Living) Including Decision-Making Capacity Use Of Standardized | 0510 | Clinic | $300.65 |
| 99496 | Transj Care Mgmt High F2f 7d, Transitional Care Management Services With The Following Required Elements Communication Direct Contact 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 | 0510 | Clinic | $409.03 |
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 Cigna Rate |
|---|---|---|---|---|
| 36556 | Catheter Insertion Into Vein, Surgical Placement Of A Thin Tube (Catheter) Into A Large Vein Near The Heart. This Is For Direct Repeated Access To The Vein To Give Fluids Medications Or To Draw Blood. | 0120 | Room & board - semi-private | $352.01 |
| 36620 | Catheter Insertion Into Artery, Insertion Of A Thin Tube (Catheter) Into An Artery. The Catheter May Be Used To Obtain Blood Samples Monitor Vital Signs Or Deliver Blood Products Or An Infusion Such As For Chemotherapy. | 0120 | Room & board - semi-private | $76.24 |
| 49083 | Remove Fluid From Abdomen, A Procedure To Remove Excess Fluid That Has Accumulated In The Abdomen. In Some Cases Scans Are Used To Help View The Area. | 0120 | Room & board - semi-private | $204.86 |
| 32554 | Drainage Of Fluid Around Lungs, A Procedure To Drain Fluid Surrounding The Lungs And Reinflate The Lungs With A Needle Or Tube. Imaging Guidance May Be Used To Better View The Area. | 0120 | Room & board - semi-private | $505.63 |
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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