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CPT code 99418: Prolonged E/M, inpatient or observation2026 Medicare rate & RVUs

CPT 99418 identifies each additional 15 minutes of prolonged physician or qualified health professional time for inpatient or observation E/M.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · 99418

Prolonged E/M, inpatient or observation

Office or facility?

Work RVUs
0.81
Total RVUs
1.04
Global days
ZZZ

National rate · 2026

—

Not priced in the facility setting.

See every locality for 99418 →Billed by an NP, PA or therapist? →

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

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What 99418 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What 99418 covers

CPT 99418 is an add-on code for prolonged evaluation and management work by a physician or other qualified health professional in the hospital inpatient or observation setting. It represents additional time associated with an inpatient or observation E/M service, rather than a separate visit. Examples of base services in this family include initial hospital care, subsequent hospital care, and same-day admission and discharge services.

Medicare marks 99418 as not valid for Medicare and uses G0316 to report and pay for this service. For Medicare claims, report G0316 when its requirements are met, not 99418. Each unit of 99418 represents an additional 15 minutes. Documentation should support the prolonged time and its relationship to the underlying inpatient or observation E/M service.

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 99418 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

99418 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

99418 rates by state

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

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
99418 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the 99418 rate is calculated

Each of 99418’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 · 99418

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.81

0.81 RVUs× 1.000 GPCI

Practice expense0.18

0.18 RVUs× 1.000 GPCI

Malpractice0.05

0.05 RVUs× 1.000 GPCI

Adjusted RVUs

1.0400

Conversion factor

$33.4009

Medicare rate

$34.74

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for 99418

The CMS indicators that decide how 99418 is paid alongside other services.

CMS payment indicators · 99418

Prolonged E/M, inpatient or observation

RuleCMS valueWhat it means
Global periodZZZAdd-on code: falls within the primary procedure’s global period.
Multiple procedures9The concept doesn’t apply.
Bilateral (modifier 50)9The concept doesn’t apply.
Assistant at surgery (80/81/82/AS)9The concept doesn’t apply.
Co-surgeons (62)9The concept doesn’t apply.
Team surgery (66)9The concept doesn’t apply.
Professional/technical9The concept doesn’t apply.

99418 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • 99418

    Prolonged E/M, inpatient or observation0.81 wRVU

    Not priced

  • G0316

    Prolonged E/M, inpatient or observation care0.61 wRVU

    $34.74

  • 99417

    Prolonged E/M, office or outpatient0.61 wRVU

    Not priced

  • 99415

    Prolonged staff care, first hour, outpatient E/M0 wRVU

    $23.05

How to choose

G0316Prolonged E/MInpatient or observation care
G0316 is the code Medicare uses for prolonged inpatient or observation E/M service. Medicare marks 99418 as not valid.
99417Prolonged E/MOffice or outpatient
99417 applies to prolonged outpatient E/M; 99418 is for prolonged inpatient or observation E/M.
99415Prolonged staff careFirst hour, outpatient E/M
99415 describes prolonged clinical staff service, not prolonged physician or qualified health professional inpatient or observation E/M.

Codes related to 99418

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

Codes related to 99418
CodeHow it relatesNational office range
Used instead
G0316Prolonged E/M, inpatient or observation careMedicare uses this code to report and pay for the prolonged inpatient or observation E/M service.$32.14–$45.00
99417Prolonged E/M, office or outpatientProlonged-service code associated with outpatient E/M rather than inpatient or observation E/M.No office rate
Primary code
99223Initial hospital visit, high decision making or 75 minutesInitial hospital care E/M that may be the primary service for prolonged time.No office rate
99233Hospital follow-up visit, subsequent day, high complexitySubsequent hospital care E/M that may be the primary service for prolonged time.No office rate
99236Hospital care, same-date admission and dischargeSame-day hospital admission and discharge E/M that may be the primary service for prolonged time.No office rate

99418 billing questions

Can 99418 be reported to Medicare?

No. Medicare marks 99418 as not valid and uses G0316 to report and pay for this service.

How does 99418 differ from 99417?

99418 is for prolonged inpatient or observation E/M time. 99417 is the corresponding prolonged-service code associated with outpatient E/M.

Which services can 99418 accompany?

It is an add-on for qualifying inpatient or observation E/M services, including initial hospital care, subsequent hospital care, and same-day admission and discharge services.

What does one unit of 99418 represent?

One unit represents an additional 15 minutes. Medicare claims use G0316 instead.

What should the record support?

Document the physician’s or qualified health professional’s prolonged time and its connection to the underlying inpatient or observation E/M service.

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

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