No office rate
Both describe initial inpatient or observation care. Choose 99221 for straightforward or low MDM, or 40 through 54 minutes when selecting by time; 99222 requires moderate MDM or at least 55 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
99222 Initial hospital visit Medicare reimbursement rates
Report initial inpatient or observation care when a physician or qualified practitioner performs the first hospital evaluation at moderate MDM or at least 55 minutes. Compare 99222 office and facility rates across CMS payment localities.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99222?
The service location and office or facility setting determine which base rate applies. These are the supported base rates for the 109 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Where 99222 pays more and less
Evaluation and management
About 99222: Initial inpatient or observation care, moderate complexity
Report initial inpatient or observation care when a physician or qualified practitioner performs the first hospital evaluation at moderate MDM or at least 55 minutes.
This service is the first hospital evaluation by a physician or qualified practitioner during an inpatient admission or observation stay. A hospitalist or admitting physician may assess a patient hospitalized for pneumonia, a COPD exacerbation, or worsening heart failure; a specialist may also use the initial hospital care family for a first evaluation during the stay. The diagnosis alone does not establish the level. The clinician’s assessment, review of available records and results, treatment decisions, and communication with other clinicians help establish the work performed.
Select 99222 for moderate medical decision making (MDM) or at least 55 minutes of the billing practitioner’s total time on the encounter date. Document the problems addressed, data considered, and management risk when selecting by MDM, or document total time when selecting by time. An initial hospital care service is generally reported once per admission by a physician or practitioners of the same specialty in the same group. For Medicare, the principal physician of record identifies the admission service with modifier AI; other physicians reporting initial hospital care omit it. If admission and discharge occur on the same date, Medicare uses a combined service code when the stay lasts at least eight hours.
Where the value comes from
- Work RVU2.60 · 74%
- Practice expense (office) RVU0.67 · 19%
- Malpractice RVU0.23 · 7%
6M
Medicare services in 2024 · #36 by national volume
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.
99222 compared with similar codes
Office rate ranges across all CMS payment localities, from the same CMS release.
No office rate
99222 is an initial hospital evaluation by the practitioner; 99232 is a subsequent inpatient or observation visit supported by moderate MDM or its applicable time minimum.
No office rate
For Medicare, choose 99235 for moderate-level admission and discharge care on the same date when the stay lasts at least eight hours. A shorter same-date stay may support 99222 without a separate discharge code.
$161.84–$222.54
99204 is a new-patient office or outpatient E/M visit. Use the initial hospital care family for an inpatient admission or observation evaluation.
See how rates vary across the country
99222 · Office / nonfacility · Non-QP. Choose a state to explore its payment localities. A range means the amount varies within that state.
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 all state and territory rates as a table
| State / territory | Rate range | Localities |
|---|---|---|
| AK | No published base rate | 1 |
| AL | No published base rate | 1 |
| AR | No published base rate | 1 |
| AZ | No published base rate | 1 |
| CA | No published base rate | 29 |
| CO | No published base rate | 1 |
| CT | No published base rate | 1 |
| DC | No published base rate | 1 |
| DE | No published base rate | 1 |
| FL | No published base rate | 3 |
| GA | No published base rate | 2 |
| GU | No published base rate | 1 |
| HI | No published base rate | 1 |
| IA | No published base rate | 1 |
| ID | No published base rate | 1 |
| IL | No published base rate | 4 |
| IN | No published base rate | 1 |
| KS | No published base rate | 1 |
| KY | No published base rate | 1 |
| LA | No published base rate | 2 |
| MA | No published base rate | 2 |
| MD | No published base rate | 3 |
| ME | No published base rate | 2 |
| MI | No published base rate | 2 |
| MN | No published base rate | 1 |
| MO | No published base rate | 3 |
| MS | No published base rate | 1 |
| MT | No published base rate | 1 |
| NC | No published base rate | 1 |
| ND | No published base rate | 1 |
| NE | No published base rate | 1 |
| NH | No published base rate | 1 |
| NJ | No published base rate | 2 |
| NM | No published base rate | 1 |
| NV | No published base rate | 1 |
| NY | No published base rate | 5 |
| OH | No published base rate | 1 |
| OK | No published base rate | 1 |
| OR | No published base rate | 2 |
| PA | No published base rate | 2 |
| PR | No published base rate | 1 |
| RI | No published base rate | 1 |
| SC | No published base rate | 1 |
| SD | No published base rate | 1 |
| TN | No published base rate | 1 |
| TX | No published base rate | 8 |
| UT | No published base rate | 1 |
| VA | No published base rate | 2 |
| VI | No published base rate | 1 |
| VT | No published base rate | 1 |
| WA | No published base rate | 2 |
| WI | No published base rate | 1 |
| WV | No published base rate | 1 |
| WY | No published base rate | 1 |
Compare 99222 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
109 of 109 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Alabama | Office Unavailable | Facility $110.77 |
| Alaska* | Office Unavailable | Facility $158.33 |
| Arizona | Office Unavailable | Facility $115.10 |
| Arkansas | Office Unavailable | Facility $110.02 |
| Atlanta | Office Unavailable | Facility $119.07 |
| Austin | Office Unavailable | Facility $117.50 |
| Bakersfield | Office Unavailable | Facility $117.70 |
| Baltimore/Surr. Cntys | Office Unavailable | Facility $121.75 |
| Beaumont | Office Unavailable | Facility $114.34 |
| Brazoria | Office Unavailable | Facility $115.71 |
| Chicago | Office Unavailable | Facility $127.57 |
| Chico | Office Unavailable | Facility $116.96 |
| Colorado | Office Unavailable | Facility $117.70 |
| Connecticut | Office Unavailable | Facility $121.98 |
| Dallas | Office Unavailable | Facility $116.50 |
| Dc + Md/Va Suburbs | Office Unavailable | Facility $126.44 |
| Delaware | Office Unavailable | Facility $116.29 |
| Detroit | Office Unavailable | Facility $121.39 |
| East St. Louis | Office Unavailable | Facility $122.90 |
| El Centro | Office Unavailable | Facility $117.00 |
| Fort Lauderdale | Office Unavailable | Facility $123.40 |
| Fort Worth | Office Unavailable | Facility $116.38 |
| Fresno | Office Unavailable | Facility $116.96 |
| Galveston | Office Unavailable | Facility $116.12 |
| Hanford-Corcoran | Office Unavailable | Facility $116.96 |
| Hawaii, Guam | Office Unavailable | Facility $116.73 |
| Houston | Office Unavailable | Facility $120.33 |
| Idaho | Office Unavailable | Facility $111.06 |
| Indiana | Office Unavailable | Facility $111.32 |
| Iowa | Office Unavailable | Facility $110.37 |
| Kansas | Office Unavailable | Facility $110.94 |
| Kentucky | Office Unavailable | Facility $113.77 |
| Los Angeles-Long Beach-Anaheim (Los Angeles/Orange Cnty) | Office Unavailable | Facility $121.98 |
| Madera | Office Unavailable | Facility $116.96 |
| Manhattan | Office Unavailable | Facility $130.59 |
| Merced | Office Unavailable | Facility $116.96 |
| Metropolitan Boston | Office Unavailable | Facility $123.96 |
| Metropolitan Kansas City | Office Unavailable | Facility $115.36 |
| Metropolitan Philadelphia | Office Unavailable | Facility $120.87 |
| Metropolitan St. Louis | Office Unavailable | Facility $115.84 |
| Miami | Office Unavailable | Facility $129.57 |
| Minnesota | Office Unavailable | Facility $112.14 |
| Mississippi | Office Unavailable | Facility $111.79 |
| Modesto | Office Unavailable | Facility $116.96 |
| Montana** | Office Unavailable | Facility $116.89 |
| Napa | Office Unavailable | Facility $125.71 |
| Nebraska | Office Unavailable | Facility $110.40 |
| Nevada** | Office Unavailable | Facility $115.64 |
| New Hampshire | Office Unavailable | Facility $116.86 |
| New Mexico | Office Unavailable | Facility $116.59 |
| New Orleans | Office Unavailable | Facility $116.63 |
| North Carolina | Office Unavailable | Facility $112.63 |
| North Dakota** | Office Unavailable | Facility $112.34 |
| Northern Nj | Office Unavailable | Facility $126.48 |
| Nyc Suburbs/Long Island | Office Unavailable | Facility $133.27 |
| Ohio | Office Unavailable | Facility $115.02 |
| Oklahoma | Office Unavailable | Facility $112.80 |
| Oxnard-Thousand Oaks-Ventura | Office Unavailable | Facility $120.51 |
| Portland | Office Unavailable | Facility $118.81 |
| Poughkpsie/N Nyc Suburbs | Office Unavailable | Facility $124.55 |
| Puerto Rico | Office Unavailable | Facility $117.03 |
| Queens | Office Unavailable | Facility $129.93 |
| Redding | Office Unavailable | Facility $116.96 |
| Rest Of California | Office Unavailable | Facility $116.96 |
| Rest Of Florida | Office Unavailable | Facility $119.78 |
| Rest Of Georgia | Office Unavailable | Facility $115.96 |
| Rest Of Illinois | Office Unavailable | Facility $119.28 |
| Rest Of Louisiana | Office Unavailable | Facility $114.01 |
| Rest Of Maine | Office Unavailable | Facility $112.21 |
| Rest Of Maryland | Office Unavailable | Facility $117.41 |
| Rest Of Massachusetts | Office Unavailable | Facility $117.92 |
| Rest Of Michigan | Office Unavailable | Facility $115.95 |
| Rest Of Missouri | Office Unavailable | Facility $113.62 |
| Rest Of New Jersey | Office Unavailable | Facility $123.18 |
| Rest Of New York | Office Unavailable | Facility $113.50 |
| Rest Of Oregon | Office Unavailable | Facility $114.53 |
| Rest Of Pennsylvania | Office Unavailable | Facility $114.65 |
| Rest Of Texas | Office Unavailable | Facility $115.02 |
| Rest Of Washington | Office Unavailable | Facility $117.38 |
| Rhode Island | Office Unavailable | Facility $118.46 |
| Riverside-San Bernardino-Ontario | Office Unavailable | Facility $119.49 |
| Sacramento-Roseville-Folsom | Office Unavailable | Facility $120.11 |
| Salinas | Office Unavailable | Facility $119.59 |
| San Diego-Chula Vista-Carlsbad | Office Unavailable | Facility $120.38 |
| San Francisco-Oakland-Berkeley (Marin Cnty) | Office Unavailable | Facility $130.17 |
| San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty) | Office Unavailable | Facility $129.91 |
| San Jose-Sunnyvale-Santa Clara (San Benito Cnty) | Office Unavailable | Facility $132.78 |
| San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty) | Office Unavailable | Facility $131.71 |
| San Luis Obispo-Paso Robles | Office Unavailable | Facility $117.93 |
| Santa Cruz-Watsonville | Office Unavailable | Facility $119.97 |
| Santa Maria-Santa Barbara | Office Unavailable | Facility $119.49 |
| Santa Rosa-Petaluma | Office Unavailable | Facility $121.05 |
| Seattle (King Cnty) | Office Unavailable | Facility $124.92 |
| South Carolina | Office Unavailable | Facility $114.05 |
| South Dakota** | Office Unavailable | Facility $111.80 |
| Southern Maine | Office Unavailable | Facility $113.87 |
| Stockton | Office Unavailable | Facility $116.96 |
| Suburban Chicago | Office Unavailable | Facility $124.05 |
| Tennessee | Office Unavailable | Facility $111.31 |
| Utah | Office Unavailable | Facility $114.78 |
| Vallejo | Office Unavailable | Facility $125.33 |
| Vermont | Office Unavailable | Facility $112.88 |
| Virgin Islands | Office Unavailable | Facility $117.03 |
| Virginia | Office Unavailable | Facility $114.26 |
| Visalia | Office Unavailable | Facility $116.96 |
| West Virginia | Office Unavailable | Facility $117.28 |
| Wisconsin | Office Unavailable | Facility $110.65 |
| Wyoming** | Office Unavailable | Facility $114.91 |
| Yuba City | Office Unavailable | Facility $116.96 |
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99222 billing questions
How is 99222 chosen over 99221 or 99223?
Choose 99222 for moderate MDM or at least 55 minutes of practitioner time. If selecting by time, 40 through 54 minutes supports 99221, while 75 minutes or more supports 99223; select the highest level supported by MDM or time.
Can 99222 be used for observation patients?
Yes. The initial hospital care family covers both inpatient admissions and observation stays; select 99222 when moderate MDM or the 55-minute minimum is met.
What if admission and discharge occur on the same calendar date?
For Medicare, report the appropriate combined admission-and-discharge code from 99234–99236 when the stay lasts at least eight hours. For a shorter same-date stay, report the supported initial hospital care code without a separate discharge service.
Who appends modifier AI to 99222?
For Medicare, the principal physician of record appends AI to identify the admission service. Other physicians reporting their first hospital evaluation use the supported initial hospital care code without AI.
Is an ED or office visit on the admission date billed separately?
When the admitting physician performs an office or ED evaluation before admitting the patient that day, Medicare includes that work in the hospital admission E/M service rather than paying a separate E/M visit.
What counts toward the 55 minutes?
Count the billing practitioner’s face-to-face and qualifying non-face-to-face work on the encounter date, such as reviewing records, documenting, ordering tests, and coordinating care. Exclude time spent on separately reported services.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense, and malpractice RVUs, adjusted by each locality’s geographic indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,01699214,,Office o/p est mod 30 min,A,,1.92,2.00,,0.47,,0.14,4.06,2.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01799215,,Office o/p est hi 40 min,A,,2.80,2.75,,0.75,,0.21,5.76,3.76,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01899221,,1st hosp ip/obs sf/low 40,A,,1.63,0.41,NA,0.41,,0.19,2.23,2.23,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01999222,,1st hosp ip/obs moderate 55,A,,2.60,0.67,NA,0.67,,0.23,3.50,3.50,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,02099223,,1st hosp ip/obs high 75,A,,3.50,0.90,NA,0.90,,0.28,4.68,4.68,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,02199231,,Sbsq hosp ip/obs sf/low 25,A,,1.00,0.24,NA,0.24,,0.08,1.32,1.32,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,02299232,,Sbsq hosp ip/obs moderate 35,A,,1.59,0.40,NA,0.40,,0.12,2.11,2.11,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00