CPT code 99235: Hospital care, same-day, moderate complexity2026 Medicare rate & RVUs

Medicare pays $142.96 for 99235 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 99235 covers

99235 represents hospital inpatient or observation care when the same physician or qualified health care professional admits and discharges the patient on the same calendar date, with moderate medical decision making. Hospitalists and other attending clinicians may report it after assessing an acute problem, starting treatment or monitoring, and determining that the patient can leave that day. The service combines the admission and discharge work rather than representing an admission alone.

Select the code based on moderate medical decision making or total time. When time is the basis, the physician’s or qualified health care professional’s total time on the date must meet or exceed 70 minutes. Document the same-day admission and discharge, the assessment and plan supporting the selected level, and total time when used. CMS fee-schedule valuation treats this as one combined E/M service; admission and discharge work for that date are not split into separate services.

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 99235 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

99235 rates by state

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

How the 99235 rate is calculated

Each of 99235’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 99235

99235 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.

99235 compared with similar codes

How to choose

99234Hospital careSame-day admission and discharge

Both cover same-date admission and discharge. Choose 99234 for straightforward or low-level care; 99235 is for moderate-level care.

99236Hospital careSame-date admission and discharge

Both cover same-date admission and discharge. 99236 requires high-level care, whereas 99235 represents moderate-level care.

99222Initial hospital visitModerate MDM or 55 minutes

99222 is initial hospital inpatient or observation care, not the combined same-day admission and discharge service represented by 99235.

99238Hospital discharge30 minutes or less

99238 reports discharge management on its own; 99235 combines admission and discharge when both occur on the same date.

Codes related to 99235

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