CPT code 99236: Hospital care, same-date admission and discharge2026 Medicare rate & RVUs in California

CMS doesn’t publish an office rate for 99236 in California.

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

What 99236 covers

This service covers a high-complexity evaluation and management encounter in which a physician or other qualified health care professional admits a patient to inpatient or observation care and discharges the patient on that same calendar date. It may be used in a hospital setting when the patient’s condition and care needs warrant a high level of decision making, such as a serious acute presentation requiring substantial evaluation and management before safe discharge.

Choose this level when medical decision making is high or, when selecting by time, the reporting professional’s total time on the date meets or exceeds 85 minutes. The record should establish the admission and discharge dates and support the selected level through the medical decision-making elements or a time statement. Report one combined same-date service rather than separate admission and discharge E/M services. Medicare values the service through the physician fee schedule.

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 99236 pays more and less in California

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

29 of 29 payment localities

How the 99236 rate is calculated

Each of 99236’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 99236

99236 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.

99236 compared with similar codes

How to choose

99235Hospital careSame-day, moderate complexity

Both cover same-date hospital admission and discharge; 99235 represents moderate rather than high medical decision making, or its corresponding time-based level.

99223Initial hospital visitHigh decision making or 75 minutes

Use 99223 for initial hospital care when the patient is not admitted and discharged on the same date; 99236 combines those same-date services.

99238Hospital discharge30 minutes or less

99238 is discharge management for a discharge on a later date, rather than a same-date admission-and-discharge encounter.

Codes related to 99236

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