Billing code 99233: Hospital follow-up visitMedicare rate & RVUs

Medicare pays $106.88 for 99233 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 99233 covers

This subsequent hospital visit is for a patient receiving inpatient or observation care after the initial hospital encounter. A hospitalist, internist, specialist, nurse practitioner, or physician assistant may assess a worsening condition, adjust treatment, and coordinate care. Situations may include worsening sepsis or heart failure that is not responding to diuresis, but the diagnosis alone does not establish the visit level. An intensivist may report this visit when the work does not meet critical care reporting requirements.

Select 99233 using high medical decision making or at least 50 minutes of the reporting practitioner's total time on the calendar date. Qualifying time can include reviewing records, discussing management with other clinicians, counseling family when appropriate, and documenting the visit; exclude time spent on separately reported services. For medical decision making, documentation must support a high level in two of its three elements, such as problems addressed, data, and management risk. Record total time when selecting by time. The same subsequent-care series covers inpatient and observation stays. CMS reports equal office and facility practice expense values for this code, although most reported Medicare services are in facilities.

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 99233 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

99233 rates by state

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

How the 99233 rate is calculated

Each of 99233’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 99233

99233 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.

99233 compared with similar codes

How to choose

99232Subsequent hospital visit

99232 requires moderate medical decision making or at least 35 minutes; 99233 requires high medical decision making or at least 50 minutes. A worsening diagnosis alone does not establish high decision making.

99223Initial hospital visit

99223 is high-level initial hospital care; 99233 is high-level subsequent care during the inpatient or observation stay.

99236Hospital care

99236 covers high-level hospital care with admission and discharge on the same date; 99233 covers a subsequent visit during an ongoing stay.

99291Critical care

99291 requires at least 30 minutes of qualifying critical care for a critically ill or injured patient. Use 99233 for a subsequent high-level hospital visit when critical care reporting requirements are not met.

Codes related to 99233

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