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 Initial hospital visit Medicare reimbursement rates in Connecticut
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. Compare 99223 office and facility rates across CMS payment localities in Connecticut.
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 99223 in Connecticut?
Connecticut 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
$162.93
1 of 1 localities have a supported rate.
Payment area: Connecticut
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 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 Connecticut, 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.
Compare 99223 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
Connecticut →
Office / nonfacility
Unavailable
Facility
$162.93
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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 99223 in Connecticut.
PPRRVU2026_Oct_nonQPP.csv
13,020
- Code
- 99223
- Physician work
- 3.50
- Practice expense
- 0.90
- Malpractice
- 0.28
GPCI2026.csv
38
- Locality
- Connecticut
- Physician work
- 1.020
- Practice expense
- 1.077
- Malpractice
- 1.210
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 3.50 | × 1.020 | 3.5700 |
| Practice expense | 0.90 | × 1.077 | 0.9693 |
| Malpractice | 0.28 | × 1.210 | 0.3388 |
| Total RVUs | 4.8781 | ||
| Conversion factor | × 33.4009 | ||
Facility rate, Connecticut$162.93
Explore RVUs, geographic factors and the full formula
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 3.5 | 1.02 |
| Practice expense | 0.9 | 1.077 |
| Malpractice | 0.28 | 1.21 |
(3.5 × 1.02 + 0.9 × 1.077 + 0.28 × 1.21) × $33.4009 = $162.93
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.
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
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
4109102,FL,03,FORT LAUDERDALE,1.000,1.013,1.808