Billing code 99231: Subsequent hospital visitMedicare rate & RVUs in Texas
Report a subsequent hospital inpatient or observation visit when medical decision making is straightforward or low, or practitioner time reaches 25 minutes.
CMS doesn’t publish an office rate for 99231 in Texas.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 99231 covers
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.
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 99231 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Unavailable | $44.32 |
| Beaumont | Unavailable | $43.18 |
| Brazoria | Unavailable | $43.70 |
| Dallas | Unavailable | $43.98 |
| Fort Worth | Unavailable | $43.93 |
| Galveston | Unavailable | $43.84 |
| Houston | Unavailable | $45.30 |
| Rest Of Texas | Unavailable | $43.42 |
How the 99231 rate is calculated
Each of 99231’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.
How the rate is built · 99231
RVUs × geographic indexes × conversion factor
Work1.00
1.00 RVUs× 1.000 GPCI
Practice expense0.24
0.24 RVUs× 1.000 GPCI
Malpractice0.08
0.08 RVUs× 1.000 GPCI
Adjusted RVUs
1.3200
Conversion factor
$33.4009
Medicare rate
$44.09
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99231
99231 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.
Place of service · 99231
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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99231 isn’t priced in this setting.
99231 compared with similar codes
Compare codes · National
5 codes, side by side
How to choose
- 99221Initial hospital care
- 99221 is initial hospital inpatient or observation care at straightforward or low complexity; 99231 is for a subsequent visit during the stay.
- 99232Subsequent hospital visit
- 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.
- 99238Hospital discharge
- 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.
- 99213Office visit
- 99213 is an established-patient office or outpatient visit; 99231 is subsequent care for a hospital inpatient or observation patient.
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 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
Show the CMS file lines behind this rate
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