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

In Rhode Island, Medicare pays $44.70 for 99231 in a facility. There’s no office rate.

Check a contract rate as a % of Medicare · 99231 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 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.

How Rhode Island compares for 99231

Across 109 of 109 payment localities, the facility rate for 99231 runs from $41.66 in Arkansas to $60.11 in Alaska. Rhode Island pays $44.70. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99231 rates by state

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

See 99231 in every payment locality

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.

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.

Codes related to 99231

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

How 99231 has changed in Rhode Island

Price 99231 for an earlier date of service

Where the Rhode Island rate applies

Rhode Island is a Medicare payment area, not a city. Our Census mapping connects it to 36 cities and communities in Rhode Island. Some span more than one payment area; confirm with the service ZIP.

• Ashaway
• Bradford
• Carolina
• Central Falls
• Charlestown
• Chepachet
• Clayville
• Cranston

Browse all communities in Rhode Island

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