CPT code 99222: Initial hospital visit, moderate MDM or 55 minutes2026 Medicare rate & RVUs in Missouri
Report initial inpatient or observation care when a physician or qualified practitioner performs the first hospital evaluation at moderate MDM or at least 55 minutes.
CMS doesn’t publish an office rate for 99222 in Missouri.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99222 covers
This service is the first hospital evaluation by a physician or qualified practitioner during an inpatient admission or observation stay. A hospitalist or admitting physician may assess a patient hospitalized for pneumonia, a COPD exacerbation, or worsening heart failure; a specialist may also use the initial hospital care family for a first evaluation during the stay. The diagnosis alone does not establish the level. The clinician’s assessment, review of available records and results, treatment decisions, and communication with other clinicians help establish the work performed.
Select 99222 for moderate medical decision making (MDM) or at least 55 minutes of the billing practitioner’s total time on the encounter date. Document the problems addressed, data considered, and management risk when selecting by MDM, or document total time when selecting by time. An initial hospital care service is generally reported once per admission by a physician or practitioners of the same specialty in the same group. For Medicare, the principal physician of record identifies the admission service with modifier AI; other physicians reporting initial hospital care omit it. If admission and discharge occur on the same date, Medicare uses a combined service code when the stay lasts at least eight hours.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99222 pays more and less in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $115.36 |
| Metropolitan St. Louis, MO | Unavailable | $115.84 |
| Rest of Missouri | Unavailable | $113.62 |
How the 99222 rate is calculated
Each of 99222’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99222
RVUs × geographic indexes × conversion factor
Work2.60
2.60 RVUs× 1.000 GPCI
Practice expense0.67
0.67 RVUs× 1.000 GPCI
Malpractice0.23
0.23 RVUs× 1.000 GPCI
Adjusted RVUs
3.5000
Conversion factor
$33.4009
Medicare rate
$116.90
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99222
99222 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99222
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99222 isn’t priced in this setting.
99222 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99221Initial hospital careStraightforward or low MDM, 40 minutes
- Both describe initial inpatient or observation care. Choose 99221 for straightforward or low MDM, or 40 through 54 minutes when selecting by time; 99222 requires moderate MDM or at least 55 minutes.
- 99232Subsequent hospital visitModerate MDM or 35 minutes
- 99222 is an initial hospital evaluation by the practitioner; 99232 is a subsequent inpatient or observation visit supported by moderate MDM or its applicable time minimum.
- 99235Hospital careSame-day, moderate complexity
- For Medicare, choose 99235 for moderate-level admission and discharge care on the same date when the stay lasts at least eight hours. A shorter same-date stay may support 99222 without a separate discharge code.
- 99204Office visitNew patient, moderate complexity
- 99204 is a new-patient office or outpatient E/M visit. Use the initial hospital care family for an inpatient admission or observation evaluation.
99222 billing questions
How is 99222 chosen over 99221 or 99223?
Choose 99222 for moderate MDM or at least 55 minutes of practitioner time. If selecting by time, 40 through 54 minutes supports 99221, while 75 minutes or more supports 99223; select the highest level supported by MDM or time.
Can 99222 be used for observation patients?
Yes. The initial hospital care family covers both inpatient admissions and observation stays; select 99222 when moderate MDM or the 55-minute minimum is met.
What if admission and discharge occur on the same calendar date?
For Medicare, report the appropriate combined admission-and-discharge code from 99234–99236 when the stay lasts at least eight hours. For a shorter same-date stay, report the supported initial hospital care code without a separate discharge service.
Who appends modifier AI to 99222?
For Medicare, the principal physician of record appends AI to identify the admission service. Other physicians reporting their first hospital evaluation use the supported initial hospital care code without AI.
Is an ED or office visit on the admission date billed separately?
When the admitting physician performs an office or ED evaluation before admitting the patient that day, Medicare includes that work in the hospital admission E/M service rather than paying a separate E/M visit.
What counts toward the 55 minutes?
Count the billing practitioner’s face-to-face and qualifying non-face-to-face work on the encounter date, such as reviewing records, documenting, ordering tests, and coordinating care. Exclude time spent on separately reported services.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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