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CPT code 99231: Subsequent hospital visit, straightforward or low MDM, 25 minutes2026 Medicare rate & RVUs

Report a subsequent hospital inpatient or observation visit when medical decision making is straightforward or low, or practitioner time reaches 25 minutes.

CMS RVU26DEffective Oct 1, 2026109 payment localities4.1M Medicare services in 2024

Medicare pays $44.09 for 99231 nationally in a facility.

Medicare rate · 99231

Subsequent hospital visit, straightforward or low MDM, 25 minutes

Office or facility?

Work RVUs
1
Total RVUs
1.32
Global days
XXX

National rate · 2026

$44.09

Facility setting, before claim adjustments.

See every locality for 99231 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99231 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99231 covers

Physicians and qualified health care professionals, including hospitalists, nurse practitioners, physician assistants, and consulting specialists, use this level for later inpatient or observation visits during a hospital stay. A rounding visit may involve checking interval symptoms, reviewing new laboratory results, and continuing or adjusting the care plan. The level depends on documented medical decision making or practitioner time, not simply whether the patient appears stable or the encounter is brief.

Report 99231 for straightforward or low medical decision making, or when the billing practitioner spends at least 25 minutes on the date of service. Medical decision making is determined from the problems addressed, data reviewed or analyzed, and management risk; two of those three elements must support the selected level. Count qualifying same-day practitioner time, including work away from the bedside, but exclude time spent on separately reported services. Document the assessment and plan, medically appropriate history and examination when performed, and total time if selecting by time. Initial care and discharge management have separate codes; another practitioner may report a medically necessary subsequent visit on the discharge date.

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 99231 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99231 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailable$41.93
AlaskaUnavailable$60.11
ArizonaUnavailable$43.46
ArkansasUnavailable$41.66
Atlanta, GAUnavailable$44.85
Austin, TXUnavailable$44.32
Bakersfield, CAUnavailable$44.45
Baltimore area, MDUnavailable$45.84
Beaumont, TXUnavailable$43.18
Brazoria, TXUnavailable$43.70

99231 rates by state

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

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Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99231 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99231 rate is calculated

Each of 99231’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 · 99231

RVUs × geographic indexes × conversion factor

Office or facility?

Work1.00

1.00 RVUs× 1.000 GPCI

Practice expense0.24

0.24 RVUs× 1.000 GPCI

Malpractice0.08

0.08 RVUs× 1.000 GPCI

Adjusted RVUs

1.3200

Conversion factor

$33.4009

Medicare rate

$44.09

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99231

99231 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 · 99231

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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99231 isn’t priced in this setting.

99231 compared with similar codes

Compare codes · National

5 codes, side by side

Office or facility?

  • 99231

    Subsequent hospital visit, straightforward or low MDM, 25 minutes1 wRVU

    Not priced

  • 99221

    Initial hospital care, straightforward or low MDM, 40 minutes1.63 wRVU

    Not priced

  • 99232

    Subsequent hospital visit, moderate MDM or 35 minutes1.59 wRVU

    Not priced

  • 99238

    Hospital discharge, 30 minutes or less1.5 wRVU

    Not priced

  • 99213

    Office visit, established patient, low complexity1.3 wRVU

    $95.19

How to choose

99221Initial hospital careStraightforward or low MDM, 40 minutes
99221 is initial hospital inpatient or observation care at straightforward or low complexity; 99231 is for a subsequent visit during the stay.
99232Subsequent hospital visitModerate MDM or 35 minutes
Choose 99232 for moderate medical decision making or at least 35 minutes of total time. Choose 99231 for straightforward or low decision making or at least 25 minutes.
99238Hospital discharge30 minutes or less
99238 covers discharge management of 30 minutes or less by the discharging practitioner. Another practitioner may report 99231 for a medically necessary subsequent visit on the discharge date.
99213Office visitEstablished patient, low complexity
99213 is an established-patient office or outpatient visit; 99231 is subsequent care for a hospital inpatient or observation patient.

Codes related to 99231

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

Codes related to 99231
CodeHow it relatesNational office range
Same family
99232Subsequent hospital visit, moderate MDM or 35 minutesNext subsequent-care level: moderate decision making or at least 35 minutes of total time.No office rate
99233Hospital follow-up visit, subsequent day, high complexityHighest subsequent-care level: high decision making or at least 50 minutes of total time.No office rate
Used instead
99221Initial hospital care, straightforward or low MDM, 40 minutesInitial inpatient or observation care at straightforward or low complexity, rather than subsequent care.No office rate
99234Hospital care, same-day admission and dischargeStraightforward or low-level hospital care when admission and discharge occur on the same date.No office rate
99307Nursing facility visit, subsequent visit, straightforward MDMSubsequent care for a patient in a nursing facility rather than a hospital.$38.87–$54.13
99213Office visit, established patient, low complexityEstablished-patient office or outpatient visit at low complexity, rather than hospital inpatient or observation care.$86.86–$120.13

99231 billing questions

How do I decide between 99231 and 99232?

Select 99231 for straightforward or low medical decision making, or at least 25 minutes of total practitioner time. Moderate medical decision making or at least 35 minutes supports 99232.

Can 99231 be reported for observation patients?

Yes. The subsequent hospital care codes cover both inpatient and observation status; the former separate subsequent observation codes were deleted in 2023.

Can 99231 be reported on the day of discharge?

The practitioner managing discharge reports discharge management rather than a subsequent visit for that work. Another practitioner may report 99231 for a medically necessary subsequent visit on the discharge date when its level is supported.

What counts toward the 25-minute time threshold?

Count the billing practitioner's qualifying time on the date of the visit, including reviewing results, examining the patient, documenting, and communicating with the care team. Exclude time spent on separately reported services.

How are split or shared visits with an NP or PA billed to Medicare?

For a facility visit shared by a physician and an NP or PA in the same group, the practitioner who performs the substantive portion bills 99231 with modifier FS. The substantive portion is more than half the total distinct time or the substantive part of medical decision making.

Can a consultant use 99231 for follow-up visits?

Yes. After a consultant's initial inpatient or observation visit, a later medically necessary visit may be reported with 99231 when its level is supported. Medicare uses initial hospital care codes, rather than consultation codes, for the consultant's initial visit.

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
RVUs for 99231PPRRVU2026_Oct_nonQPP.csv, line 13,021 (RVU26D)

Open CMS sourceHow we calculate rates

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