No office rate
99221 is initial hospital inpatient or observation care at straightforward or low complexity; 99231 is for a subsequent visit during the stay.
On this page
CMS RVU26D · Effective 2026-10-01
99231 Subsequent hospital visit Medicare reimbursement rates in Colorado
Report a subsequent hospital inpatient or observation visit when medical decision making is straightforward or low, or practitioner time reaches 25 minutes. Compare 99231 office and facility rates across CMS payment localities in Colorado.
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 99231 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$44.42
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
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.
Evaluation and management
About 99231: Subsequent inpatient or observation care, low complexity
Report a subsequent hospital inpatient or observation visit when medical decision making is straightforward or low, or practitioner time reaches 25 minutes.
Physicians and qualified health care professionals, including hospitalists, nurse practitioners, physician assistants, and consulting specialists, use this level for later inpatient or observation visits during a hospital stay. A rounding visit may involve checking interval symptoms, reviewing new laboratory results, and continuing or adjusting the care plan. The level depends on documented medical decision making or practitioner time, not simply whether the patient appears stable or the encounter is brief.
Report 99231 for straightforward or low medical decision making, or when the billing practitioner spends at least 25 minutes on the date of service. Medical decision making is determined from the problems addressed, data reviewed or analyzed, and management risk; two of those three elements must support the selected level. Count qualifying same-day practitioner time, including work away from the bedside, but exclude time spent on separately reported services. Document the assessment and plan, medically appropriate history and examination when performed, and total time if selecting by time. Initial care and discharge management have separate codes; another practitioner may report a medically necessary subsequent visit on the discharge date.
Where the value comes from
- Work RVU1.00 · 76%
- Practice expense (office) RVU0.24 · 18%
- Malpractice RVU0.08 · 6%
4.1M
Medicare services in 2024 · #47 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.
99231 compared with similar codes
Office rates for Colorado, from the same CMS release.
No office rate
Choose 99232 for moderate medical decision making or at least 35 minutes of total time. Choose 99231 for straightforward or low decision making or at least 25 minutes.
No office rate
99238 covers discharge management of 30 minutes or less by the discharging practitioner. Another practitioner may report 99231 for a medically necessary subsequent visit on the discharge date.
$98.18
99213 is an established-patient office or outpatient visit; 99231 is subsequent care for a hospital inpatient or observation patient.
Compare 99231 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.
1 of 1 payment localities
Colorado →
Office / nonfacility
Unavailable
Facility
$44.42
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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 99231 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
13,021
- Code
- 99231
- Physician work
- 1.00
- Practice expense
- 0.24
- Malpractice
- 0.08
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.00 | × 1.012 | 1.0120 |
| Practice expense | 0.24 | × 1.064 | 0.2554 |
| Malpractice | 0.08 | × 0.781 | 0.0625 |
| Total RVUs | 1.3298 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Colorado$44.42
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1 | 1.012 |
| Practice expense | 0.24 | 1.064 |
| Malpractice | 0.08 | 0.781 |
(1 × 1.012 + 0.24 × 1.064 + 0.08 × 0.781) × $33.4009 = $44.42
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.
99231 billing questions
How do I decide between 99231 and 99232?
Select 99231 for straightforward or low medical decision making, or at least 25 minutes of total practitioner time. Moderate medical decision making or at least 35 minutes supports 99232.
Can 99231 be reported for observation patients?
Yes. The subsequent hospital care codes cover both inpatient and observation status; the former separate subsequent observation codes were deleted in 2023.
Can 99231 be reported on the day of discharge?
The practitioner managing discharge reports discharge management rather than a subsequent visit for that work. Another practitioner may report 99231 for a medically necessary subsequent visit on the discharge date when its level is supported.
What counts toward the 25-minute time threshold?
Count the billing practitioner's qualifying time on the date of the visit, including reviewing results, examining the patient, documenting, and communicating with the care team. Exclude time spent on separately reported services.
How are split or shared visits with an NP or PA billed to Medicare?
For a facility visit shared by a physician and an NP or PA in the same group, the practitioner who performs the substantive portion bills 99231 with modifier FS. The substantive portion is more than half the total distinct time or the substantive part of medical decision making.
Can a consultant use 99231 for follow-up visits?
Yes. After a consultant's initial inpatient or observation visit, a later medically necessary visit may be reported with 99231 when its level is supported. Medicare uses initial hospital care codes, rather than consultation codes, for the consultant's initial visit.
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.
13,01899221,,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
13,02499234,,Hosp ip/obs sm dt sf/low 45,A,,2.00,0.46,NA,0.46,,0.18,2.64,2.64,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
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