CPT code 99234: Hospital care, same-day admission and discharge2026 Medicare rate & RVUs

Medicare pays $88.18 for 99234 nationally in a facility.

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

What 99234 covers

A physician or other qualified health care professional reports 99234 for hospital inpatient or observation care when the patient is admitted and discharged on the same calendar date. The encounter combines the admission evaluation and discharge-day management into one service. A typical setting is a hospital observation unit evaluating a stable symptom or condition with a same-day disposition; the code level depends on the documented service, not the diagnosis alone.

Select the code based on straightforward or low medical decision making, or on at least 45 minutes of qualifying total time on the date of the encounter. Documentation should support the admission, the same-day discharge, and the medical decision making or time used to select the level. Report one combined service rather than separating the same-day care into an initial hospital-care code and a discharge-management code.

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 99234 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

99234 rates by state

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

How the 99234 rate is calculated

Each of 99234’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 99234

99234 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.

99234 compared with similar codes

How to choose

99235Hospital careSame-day, moderate complexity

Both cover same-day hospital admission and discharge; 99235 is selected for moderate medical decision making or the applicable higher time threshold.

99236Hospital careSame-date admission and discharge

Both cover same-day hospital admission and discharge; 99236 is for high medical decision making or the applicable higher time threshold.

99221Initial hospital careStraightforward or low MDM, 40 minutes

99221 reports initial hospital inpatient or observation care when the patient is not admitted and discharged on the same date.

99238Hospital discharge30 minutes or less

99238 reports discharge management when discharge occurs on a date other than the admission date, rather than the combined same-day service.

Codes related to 99234

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

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