CPT code 99235: Hospital care, same-day, moderate complexity2026 Medicare rate & RVUs in Missouri
Reports hospital inpatient or observation admission and discharge on the same date when the combined encounter supports moderate medical decision making or qualifying total time.
CMS doesn’t publish an office rate for 99235 in Missouri.
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 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 in Missouri
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Kansas City, MO | Unavailable | $141.15 |
| Metropolitan St. Louis, MO | Unavailable | $141.71 |
| Rest of Missouri | Unavailable | $139.10 |
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.
How the rate is built · 99235
RVUs × geographic indexes × conversion factor
Work3.24
3.24 RVUs× 1.000 GPCI
Practice expense0.79
0.79 RVUs× 1.000 GPCI
Malpractice0.25
0.25 RVUs× 1.000 GPCI
Adjusted RVUs
4.2800
Conversion factor
$33.4009
Medicare rate
$142.96
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
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.
Place of service · 99235
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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99235 isn’t priced in this setting.
99235 compared with similar codes
Compare codes · National
5 codes, side by side
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.
99235 billing questions
When should 99235 be selected instead of 99234 or 99236?
Use 99235 when the same-day admission and discharge encounter supports moderate medical decision making or the applicable total-time threshold. 99234 represents straightforward or low-level care, while 99236 represents high-level care.
Can admission and discharge management be billed separately on the same date?
99235 covers the combined same-day admission and discharge service. Do not divide that encounter into a separate initial hospital care service and discharge management service.
What time supports 99235?
When selecting the code by time, total physician or qualified health care professional time on the date must meet or exceed 70 minutes. There is no upper time limit.
Can 99235 be used for an observation stay?
Yes. It covers same-date admission and discharge for hospital inpatient or observation care when the encounter meets the moderate level or time criterion.
What documentation supports reporting 99235?
Document the admission and discharge on the same calendar date and the work supporting moderate medical decision making. If selecting by time, record the total time for the 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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