No office rate
99223 is initial inpatient or observation care; 99233 is high-level subsequent care after the practitioner's initial service during the stay.
On this page
CMS RVU26D · Effective 2026-10-01
99223 in Delaware
Office / nonfacility
Not available in this setting
Base rate per service
Facility setting
$155.60
Base rate per service
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.
Evaluation and management
About 99223: Initial hospital inpatient or observation care, high complexity
Report an initial inpatient or observation evaluation when the practitioner performs high-complexity medical decision making or spends at least 75 minutes on the encounter date.
This initial inpatient or observation evaluation may be performed by a hospitalist, admitting internist, or other physician or qualified health care professional seeing the patient during the stay. High-level decision making may arise with acute respiratory failure requiring decisions about intensive monitoring or severe sepsis requiring treatment escalation; the diagnosis alone does not establish the level. For Medicare patients, specialists asked to evaluate a patient during the stay select an initial hospital care code rather than an inpatient consultation code.
Select 99223 when medical decision making is high in at least two of the three elements—problems, data, and management risk—or qualifying practitioner time reaches 75 minutes on the encounter date. Document the assessment and management decisions or total time, which may include record review and documentation but excludes separately billed work. For Medicare, only the principal physician of record appends modifier AI. When the applicable prolonged-service threshold is met, Medicare uses G0316 with a time-selected 99223; payers following CPT prolonged-service rules may use 99418. An earlier same-day office or emergency visit by the same practitioner that leads to admission is incorporated into the hospital visit.
Where the value comes from
- Work RVU3.50 · 75%
- Practice expense (office) RVU0.90 · 19%
- Malpractice RVU0.28 · 6%
10.1M
Medicare services in 2024 · #21 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.
99223 compared with similar codes
Office rates for Delaware, from the same CMS release.
No office rate
Choose 99222 for moderate medical decision making or at least 55 minutes of qualifying time. Choose 99223 for high medical decision making or at least 75 minutes.
No office rate
99236 covers high-level admission and discharge care on the same date when the stay meets Medicare's eight-hour requirement. A shorter same-date stay may be reported with 99223 if its level is supported.
99255
No office rateIp/obs consltj new/est hi 80
99255 is an inpatient or observation consultation code for payers that recognize consultations. For Medicare, select an initial hospital care code, including 99223 only when its decision-making or time criterion is met.
The same code, a different location
How does Delaware compare?
99223 across payment areas
Same release and payment basis · bars start at $0
Delaware · This locality
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Unavailable
No comparable rate is available in this setting.
Other payment areas listed in Delaware appear first, followed by selected cross-country examples. The chart compares amounts, not distance.
The code’s RVUs stay the same in these comparisons. Geographic adjustments to work, practice expense and malpractice change the dollar amount. A city name alone may not identify the payment area for a service address.
Compare all 108 other payment areas
Alabama
Alabama · 99223
Office
Unavailable
Facility
$148.50
No comparable office rate is available.
Arkansas
Arkansas · 99223
Office
Unavailable
Facility
$147.54
No comparable office rate is available.
Arizona
Arizona · 99223
Office
Unavailable
Facility
$154.04
No comparable office rate is available.
Bakersfield
California · 99223
Office
Unavailable
Facility
$157.77
No comparable office rate is available.
Chico
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
El Centro
California · 99223
Office
Unavailable
Facility
$156.90
No comparable office rate is available.
Fresno
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Hanford-Corcoran
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Madera
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Merced
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Modesto
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Napa
California · 99223
Office
Unavailable
Facility
$168.64
No comparable office rate is available.
Oxnard-Thousand Oaks-Ventura
California · 99223
Office
Unavailable
Facility
$161.53
No comparable office rate is available.
Redding
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Rest Of California
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Riverside-San Bernardino-Ontario
California · 99223
Office
Unavailable
Facility
$159.93
No comparable office rate is available.
Sacramento-Roseville-Folsom
California · 99223
Office
Unavailable
Facility
$161.09
No comparable office rate is available.
Salinas
California · 99223
Office
Unavailable
Facility
$160.38
No comparable office rate is available.
San Diego-Chula Vista-Carlsbad
California · 99223
Office
Unavailable
Facility
$161.43
No comparable office rate is available.
San Francisco-Oakland-Berkeley (Marin Cnty)
California · 99223
Office
Unavailable
Facility
$174.69
No comparable office rate is available.
San Francisco-Oakland-Berkeley (San Francisco/San Mateo/Alameda/Contra Costa Cnty)
California · 99223
Office
Unavailable
Facility
$174.37
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (San Benito Cnty)
California · 99223
Office
Unavailable
Facility
$178.12
No comparable office rate is available.
San Jose-Sunnyvale-Santa Clara (Santa Clara Cnty)
California · 99223
Office
Unavailable
Facility
$176.82
No comparable office rate is available.
San Luis Obispo-Paso Robles
California · 99223
Office
Unavailable
Facility
$158.14
No comparable office rate is available.
Santa Cruz-Watsonville
California · 99223
Office
Unavailable
Facility
$160.89
No comparable office rate is available.
Santa Maria-Santa Barbara
California · 99223
Office
Unavailable
Facility
$160.24
No comparable office rate is available.
Santa Rosa-Petaluma
California · 99223
Office
Unavailable
Facility
$162.34
No comparable office rate is available.
Stockton
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Vallejo
California · 99223
Office
Unavailable
Facility
$168.18
No comparable office rate is available.
Visalia
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Yuba City
California · 99223
Office
Unavailable
Facility
$156.85
No comparable office rate is available.
Colorado
Colorado · 99223
Office
Unavailable
Facility
$157.59
No comparable office rate is available.
Connecticut
Connecticut · 99223
Office
Unavailable
Facility
$162.93
No comparable office rate is available.
Fort Lauderdale
Florida · 99223
Office
Unavailable
Facility
$164.26
No comparable office rate is available.
Rest Of Florida
Florida · 99223
Office
Unavailable
Facility
$159.70
No comparable office rate is available.
Atlanta
Georgia · 99223
Office
Unavailable
Facility
$159.03
No comparable office rate is available.
Rest Of Georgia
Georgia · 99223
Office
Unavailable
Facility
$154.87
No comparable office rate is available.
Hawaii, Guam
Hawaii · 99223
Office
Unavailable
Facility
$156.50
No comparable office rate is available.
Iowa
Iowa · 99223
Office
Unavailable
Facility
$148.12
No comparable office rate is available.
Idaho
Idaho · 99223
Office
Unavailable
Facility
$148.98
No comparable office rate is available.
East St. Louis
Illinois · 99223
Office
Unavailable
Facility
$163.39
No comparable office rate is available.
Rest Of Illinois
Illinois · 99223
Office
Unavailable
Facility
$158.97
No comparable office rate is available.
Suburban Chicago
Illinois · 99223
Office
Unavailable
Facility
$165.17
No comparable office rate is available.
Indiana
Indiana · 99223
Office
Unavailable
Facility
$149.31
No comparable office rate is available.
Kansas
Kansas · 99223
Office
Unavailable
Facility
$148.79
No comparable office rate is available.
Kentucky
Kentucky · 99223
Office
Unavailable
Facility
$152.18
No comparable office rate is available.
New Orleans
Louisiana · 99223
Office
Unavailable
Facility
$155.81
No comparable office rate is available.
Rest Of Louisiana
Louisiana · 99223
Office
Unavailable
Facility
$152.47
No comparable office rate is available.
Metropolitan Boston
Massachusetts · 99223
Office
Unavailable
Facility
$165.91
No comparable office rate is available.
Rest Of Massachusetts
Massachusetts · 99223
Office
Unavailable
Facility
$157.88
No comparable office rate is available.
Baltimore/Surr. Cntys
Maryland · 99223
Office
Unavailable
Facility
$162.60
No comparable office rate is available.
Rest Of Maryland
Maryland · 99223
Office
Unavailable
Facility
$157.08
No comparable office rate is available.
Rest Of Maine
Maine · 99223
Office
Unavailable
Facility
$150.38
No comparable office rate is available.
Southern Maine
Maine · 99223
Office
Unavailable
Facility
$152.59
No comparable office rate is available.
Detroit
Michigan · 99223
Office
Unavailable
Facility
$161.68
No comparable office rate is available.
Rest Of Michigan
Michigan · 99223
Office
Unavailable
Facility
$154.91
No comparable office rate is available.
Minnesota
Minnesota · 99223
Office
Unavailable
Facility
$150.60
No comparable office rate is available.
Metropolitan Kansas City
Missouri · 99223
Office
Unavailable
Facility
$154.27
No comparable office rate is available.
Metropolitan St. Louis
Missouri · 99223
Office
Unavailable
Facility
$154.89
No comparable office rate is available.
Rest Of Missouri
Missouri · 99223
Office
Unavailable
Facility
$151.92
No comparable office rate is available.
Mississippi
Mississippi · 99223
Office
Unavailable
Facility
$149.70
No comparable office rate is available.
Montana**
Montana · 99223
Office
Unavailable
Facility
$156.30
No comparable office rate is available.
North Carolina
North Carolina · 99223
Office
Unavailable
Facility
$150.93
No comparable office rate is available.
North Dakota**
North Dakota · 99223
Office
Unavailable
Facility
$150.76
No comparable office rate is available.
Nebraska
Nebraska · 99223
Office
Unavailable
Facility
$148.18
No comparable office rate is available.
New Hampshire
New Hampshire · 99223
Office
Unavailable
Facility
$156.38
No comparable office rate is available.
Northern Nj
New Jersey · 99223
Office
Unavailable
Facility
$169.13
No comparable office rate is available.
Rest Of New Jersey
New Jersey · 99223
Office
Unavailable
Facility
$164.67
No comparable office rate is available.
New Mexico
New Mexico · 99223
Office
Unavailable
Facility
$155.70
No comparable office rate is available.
Nevada**
Nevada · 99223
Office
Unavailable
Facility
$154.78
No comparable office rate is available.
Nyc Suburbs/Long Island
New York · 99223
Office
Unavailable
Facility
$177.49
No comparable office rate is available.
Poughkpsie/N Nyc Suburbs
New York · 99223
Office
Unavailable
Facility
$166.40
No comparable office rate is available.
Queens
New York · 99223
Office
Unavailable
Facility
$173.40
No comparable office rate is available.
Rest Of New York
New York · 99223
Office
Unavailable
Facility
$152.04
No comparable office rate is available.
Ohio
Ohio · 99223
Office
Unavailable
Facility
$153.78
No comparable office rate is available.
Oklahoma
Oklahoma · 99223
Office
Unavailable
Facility
$151.01
No comparable office rate is available.
Portland
Oregon · 99223
Office
Unavailable
Facility
$159.13
No comparable office rate is available.
Rest Of Oregon
Oregon · 99223
Office
Unavailable
Facility
$153.42
No comparable office rate is available.
Metropolitan Philadelphia
Pennsylvania · 99223
Office
Unavailable
Facility
$161.46
No comparable office rate is available.
Rest Of Pennsylvania
Pennsylvania · 99223
Office
Unavailable
Facility
$153.34
No comparable office rate is available.
Puerto Rico
Puerto Rico · 99223
Office
Unavailable
Facility
$156.51
No comparable office rate is available.
Rhode Island
Rhode Island · 99223
Office
Unavailable
Facility
$158.52
No comparable office rate is available.
South Carolina
South Carolina · 99223
Office
Unavailable
Facility
$152.63
No comparable office rate is available.
South Dakota**
South Dakota · 99223
Office
Unavailable
Facility
$150.11
No comparable office rate is available.
Tennessee
Tennessee · 99223
Office
Unavailable
Facility
$149.25
No comparable office rate is available.
Austin
Texas · 99223
Office
Unavailable
Facility
$157.23
No comparable office rate is available.
Beaumont
Texas · 99223
Office
Unavailable
Facility
$152.95
No comparable office rate is available.
Brazoria
Texas · 99223
Office
Unavailable
Facility
$154.92
No comparable office rate is available.
Dallas
Texas · 99223
Office
Unavailable
Facility
$155.92
No comparable office rate is available.
Fort Worth
Texas · 99223
Office
Unavailable
Facility
$155.74
No comparable office rate is available.
Galveston
Texas · 99223
Office
Unavailable
Facility
$155.43
No comparable office rate is available.
Houston
Texas · 99223
Office
Unavailable
Facility
$160.56
No comparable office rate is available.
Rest Of Texas
Texas · 99223
Office
Unavailable
Facility
$153.88
No comparable office rate is available.
Utah
Utah · 99223
Office
Unavailable
Facility
$153.56
No comparable office rate is available.
Virginia
Virginia · 99223
Office
Unavailable
Facility
$153.06
No comparable office rate is available.
Virgin Islands
United States Virgin Islands · 99223
Office
Unavailable
Facility
$156.51
No comparable office rate is available.
Vermont
Vermont · 99223
Office
Unavailable
Facility
$151.40
No comparable office rate is available.
Rest Of Washington
Washington · 99223
Office
Unavailable
Facility
$157.19
No comparable office rate is available.
Seattle (King Cnty)
Washington · 99223
Office
Unavailable
Facility
$167.27
No comparable office rate is available.
Wisconsin
Wisconsin · 99223
Office
Unavailable
Facility
$148.58
No comparable office rate is available.
West Virginia
West Virginia · 99223
Office
Unavailable
Facility
$156.41
No comparable office rate is available.
Wyoming**
Wyoming · 99223
Office
Unavailable
Facility
$153.88
No comparable office rate is available.
See how rates vary across the country
99223 · 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 |
Where does this rate apply?
Delaware is a Medicare payment area. Our Census mapping connects it to 79 cities and communities in Delaware, including the examples shown here.
Some communities span more than one payment area. Follow a city link to compare all of its mapped areas, or check the service-location ZIP above for an address-level starting point.
Use this rate
What is a percentage of Medicare worth?
Turn a percentage into dollars for 99223 in Delaware. This uses the base rate on this page, so the locality and release stay consistent.
Reference amount per service
$171.16
$155.60 × 110% = $171.16
A contract may specify another Medicare year or additional adjustments. This is percentage arithmetic on the displayed base rate, not a claim adjudication.
Working with a whole code list?
Compare an offer across your annual code mix, including an older Medicare schedule or flat per-code rates.
How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99223 in Delaware.
PPRRVU2026_Oct_nonQPP.csv
13,020
- Code
- 99223
- Physician work
- 3.50
- Practice expense
- 0.90
- Malpractice
- 0.28
GPCI2026.csv
40
- Locality
- Delaware
- Physician work
- 1.005
- Practice expense
- 0.988
- Malpractice
- 0.899
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.50 | × 1.005 | 3.5175 |
| Practice expense | 0.90 | × 0.988 | 0.8892 |
| Malpractice | 0.28 | × 0.899 | 0.2517 |
| Total RVUs | 4.6584 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Delaware$155.60
Open 99223 in the RVU calculator →
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1.005 |
| Practice expense | 0.9 | 0.988 |
| Malpractice | 0.28 | 0.899 |
(3.5 × 1.005 + 0.9 × 0.988 + 0.28 × 0.899) × $33.4009 = $155.60
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
How this rate has changed
99223 · Office / nonfacility
Rate unavailable
Effective 2026-10-01
A rate is unavailable in one of these releases, so a change cannot be calculated.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
Explore release dates and calculate this code in an earlier period →
Each row uses the accepted CMS release effective on that date and the same contractor and locality identifiers. Missing rates stay visible. Historical boundaries may differ; verify the service address for an older claim.
Inspect every release and its CMS source
| Effective from | Office / nonfacility | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | Not available in this setting | $155.60 | RVU26D |
| 2026-07-01 | Not available in this setting | $155.60 | RVU26C |
| 2026-04-01 | Not available in this setting | $155.60 | RVU26B |
| 2026-01-01 | Not available in this setting | $155.60 | RVU26A |
| 2025-10-01 | Not available in this setting | $167.43 | RVU25D |
| 2025-07-01 | Not available in this setting | $167.43 | RVU25C |
| 2025-04-01 | Not available in this setting | $167.43 | RVU25B |
| 2025-01-01 | Not available in this setting | $167.43 | RVU25A |
99223 billing questions
Can a consulting specialist report 99223 for a Medicare patient?
Yes, if the specialist's initial inpatient or observation evaluation meets the high medical decision-making or 75-minute criterion. Medicare does not recognize inpatient consultation codes; a specialist who is not the principal physician of record does not append modifier AI.
Who appends modifier AI?
The principal physician of record appends AI to the initial hospital care code for Medicare. Other practitioners reporting an initial hospital evaluation do not append it.
How is time beyond 75 minutes reported?
Medicare uses G0316 with a time-selected 99223 once its prolonged-service threshold is met; reaching 75 minutes alone does not support the add-on. Payers following CPT prolonged-service rules may use 99418 under its applicable threshold.
Should 99223 or 99236 be used when admission and discharge occur on the same date?
For Medicare, a stay of at least eight hours may qualify for a same-date admission and discharge code. Select 99236 only if its high-level decision-making or time criterion is met; for a shorter stay, select an initial hospital care code at the supported level.
Can an ED visit and 99223 be billed on the same date?
An ED encounter by the same practitioner that leads to admission is incorporated into the initial hospital care service. A separate emergency physician may report the ED service.
Does 99223 apply to observation patients?
Yes. The initial hospital care series covers both inpatient and observation stays.
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.
13,01799215,,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
13,02399233,,Sbsq hosp ip/obs high 50,A,,2.40,0.62,NA,0.62,,0.18,3.20,3.20,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808
4209102,FL,04,MIAMI,1.000,1.041,2.529
4309102,FL,99,REST OF FLORIDA,1.000,0.956,1.503