CPT code 99232: Subsequent hospital visit, moderate MDM or 35 minutes2026 Medicare rate & RVUs in Texas
Report a subsequent inpatient or observation visit when the practitioner's follow-up care meets moderate medical decision making or at least 35 minutes of total time.
CMS doesn’t publish an office rate for 99232 in Texas.
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 99232 covers
A physician or qualified nonphysician practitioner reports this level when following a patient receiving hospital inpatient or observation care. Hospitalists, internists, cardiologists, and nephrologists may use it while managing conditions such as heart failure, pneumonia, or acute kidney injury. The condition alone does not determine the level; the documented work must support moderate medical decision making (MDM), or the practitioner must meet the time requirement. Medicare reports this code predominantly in the facility setting.
Select 99232 by moderate MDM or at least 35 minutes of the billing practitioner's total time on the date of service, including qualifying work away from the unit. When selecting by MDM, document the problems addressed, data reviewed or analyzed, and management risk; at least two MDM elements must reach the moderate level. When selecting by time, document the total time. Practitioners in the same specialty and group generally report one hospital E/M visit per patient per day. For a split or shared visit by a physician and nonphysician practitioner in the same group, the practitioner who performed the substantive portion bills with modifier FS.
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 99232 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | Unavailable | $70.90 |
| Beaumont, TX | Unavailable | $68.99 |
| Brazoria, TX | Unavailable | $69.90 |
| Dallas, TX | Unavailable | $70.33 |
| Fort Worth, TX | Unavailable | $70.25 |
| Galveston, TX | Unavailable | $70.12 |
| Houston, TX | Unavailable | $72.31 |
| Rest of Texas | Unavailable | $69.41 |
How the 99232 rate is calculated
Each of 99232’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 · 99232
RVUs × geographic indexes × conversion factor
Work1.59
1.59 RVUs× 1.000 GPCI
Practice expense0.40
0.40 RVUs× 1.000 GPCI
Malpractice0.12
0.12 RVUs× 1.000 GPCI
Adjusted RVUs
2.1100
Conversion factor
$33.4009
Medicare rate
$70.48
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99232
99232 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 · 99232
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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99232 isn’t priced in this setting.
99232 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99214Office visitEstablished patient, moderate complexity
- 99214 is a moderate-level established patient office or outpatient visit. For a subsequent visit while the patient is receiving hospital inpatient or observation care, use 99232 when its MDM or time requirement is met.
- 99222Initial hospital visitModerate MDM or 55 minutes
- 99222 covers initial hospital care at moderate MDM or at least 55 minutes. 99232 applies to subsequent care after that practitioner or same-specialty group has provided initial hospital care.
- 99233Hospital follow-up visitSubsequent day, high complexity
- Both describe subsequent hospital care. Use 99233 for high MDM or at least 50 minutes; use 99232 for moderate MDM or at least 35 minutes.
- 99254Hospital consultationModerate, 60-minute level
- 99254 describes a moderate-level inpatient or observation consultation for payers that recognize consultation codes. Medicare does not pay consultation codes; select subsequent hospital care by the documented MDM or time for a follow-up visit.
99232 billing questions
How do I choose 99232 over 99231 or 99233?
Select the level supported by MDM or total time: 99231 for straightforward or low MDM or at least 25 minutes, 99232 for moderate MDM or at least 35 minutes, and 99233 for high MDM or at least 50 minutes. When selecting by time, report the highest level whose minimum is met.
Can 99232 be reported for an observation patient?
Yes. Subsequent hospital care codes cover both inpatient and observation status; the former separate subsequent observation codes were deleted.
What time counts toward the 35 minutes?
Count the billing practitioner's time on the date of service for work such as chart review, examination, medically appropriate family discussion, orders, care coordination, and documentation. Exclude clinical staff time and time spent on separately reported services.
Can prolonged services be added to 99232?
No. Among subsequent hospital care levels, prolonged time is reported only with 99233 when the applicable requirements are met. Select 99233 first if the documented time supports it.
How does a specialist report Medicare hospital follow-up visits?
Medicare does not pay inpatient consultation codes. After the specialist's initial hospital care visit, select 99231–99233 for follow-up care; use 99232 when moderate MDM or at least 35 minutes supports it.
Can 99232 be billed on the patient's discharge date?
A practitioner performing discharge-day management reports 99238 or 99239 instead of a subsequent care visit. A different specialist may report 99232 for a separate, medically necessary follow-up visit on that date.
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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