Billing code 99233: Hospital follow-up visitMedicare rate & RVUs in Utah
Report a subsequent inpatient or observation hospital visit when medical decision making is high or the practitioner spends at least 50 minutes that date.
CMS doesn’t publish an office rate for 99233 in Utah.
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 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.
99233 in Utah
| Payment locality | Office | Facility |
|---|---|---|
| Utah | Unavailable | $105.03 |
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.
How the rate is built · 99233
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 2.40Practice expense 0.62Malpractice 0.18
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
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.
Place of service · 99233
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
Non-facility (office) rate · national
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99233 isn’t priced in this setting.
99233 compared with similar codes
Compare codes
99233 vs 99232 vs 99223 vs 99236 vs 99291: national Medicare rates
Swap in your local Medicare rate.
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.
99233 billing questions
How do I choose between 99232 and 99233?
99232 requires moderate medical decision making or at least 35 minutes; 99233 requires high medical decision making or at least 50 minutes. For a decision-making selection, two of the three elements must support the chosen level.
Can 99233 be reported for an observation patient?
Yes. Since 2023, subsequent hospital care codes cover both inpatient and observation status; the former separate observation follow-up codes are no longer used.
How is prolonged time reported beyond 99233 for Medicare?
Medicare uses HCPCS G0316 rather than billing code 99418 when 99233 is selected by time and the service meets Medicare's prolonged-service time threshold. Reaching the 50-minute minimum for 99233 alone does not support G0316.
Can I bill 99233 on the day of discharge?
For the practitioner's discharge-day management, report 99238 or 99239 instead of a subsequent hospital visit.
How do consultants bill follow-up visits for Medicare patients?
Medicare does not pay inpatient consultation codes 99252–99255. A consultant uses an appropriate initial hospital care code for the first hospital visit and a subsequent hospital care code, including 99233 when supported, for later visits.
How is a split/shared visit with an NP or PA reported?
For a qualifying facility-based split/shared visit, the physician or NP/PA who performs the substantive portion reports the visit with modifier FS. The substantive portion is more than half of the combined, nonduplicated time or the substantive part of medical decision making under CMS rules.
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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