CPT code 99223: Initial hospital visit, high decision making or 75 minutes2026 Medicare rate & RVUs in Santa Rosa, CA

In Santa Rosa, CA, Medicare pays $162.34 for 99223 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99223 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 99223 covers

This initial inpatient or observation evaluation may be performed by a hospitalist, admitting internist, or other physician or qualified health care professional seeing the patient during the stay. High-level decision making may arise with acute respiratory failure requiring decisions about intensive monitoring or severe sepsis requiring treatment escalation; the diagnosis alone does not establish the level. For Medicare patients, specialists asked to evaluate a patient during the stay select an initial hospital care code rather than an inpatient consultation code.

Select 99223 when medical decision making is high in at least two of the three elements—problems, data, and management risk—or qualifying practitioner time reaches 75 minutes on the encounter date. Document the assessment and management decisions or total time, which may include record review and documentation but excludes separately billed work. For Medicare, only the principal physician of record appends modifier AI. When the applicable prolonged-service threshold is met, Medicare uses G0316 with a time-selected 99223; payers following CPT prolonged-service rules may use 99418. An earlier same-day office or emergency visit by the same practitioner that leads to admission is incorporated into the hospital visit.

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 Santa Rosa, CA compares for 99223

Across 109 of 109 payment localities, the facility rate for 99223 runs from $147.54 in Arkansas to $212.52 in Alaska. Santa Rosa, CA pays $162.34. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99223 rates by state

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

See 99223 in every payment locality

How the 99223 rate is calculated

Each of 99223’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 99223

99223 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 99223

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

How 99223 has changed in Santa Rosa, CA

Price 99223 for an earlier date of service

Where the Santa Rosa, CA rate applies

Santa Rosa, CA is a Medicare payment area, not a city. Our Census mapping connects it to 38 cities and communities in California. Some span more than one payment area; confirm with the service ZIP.

• 99223 in Petaluma
• 99223 in Santa Rosa
• 99223 in Bloomfield
• 99223 in Bodega
• 99223 in Bodega Bay
• 99223 in Boyes Hot Springs
• 99223 in Carmet
• 99223 in Cazadero

Browse all communities in California

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