CPT code 99222: Initial hospital visit, moderate MDM or 55 minutes2026 Medicare rate & RVUs in Utah

In Utah, Medicare pays $114.78 for 99222 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99222 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

How Utah compares for 99222

Across 109 of 109 payment localities, the facility rate for 99222 runs from $110.02 in Arkansas to $158.33 in Alaska. Utah pays $114.78. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99222 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99222 in every payment locality

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.

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.

Codes related to 99222

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99222 has changed in Utah

Price 99222 for an earlier date of service

Where the Utah rate applies

Utah is a Medicare payment area, not a city. Our Census mapping connects it to 334 cities and communities in Utah. Some span more than one payment area; confirm with the service ZIP.

• Alpine
• Alta
• Altamont
• Alton
• Amalga
• American Fork
• Aneth
• Annabella

Browse all communities in Utah

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

Open CMS sourceHow we calculate rates