No office rate
99221 is supported by straightforward or low MDM, or at least 40 minutes when selecting by time. Moderate MDM or at least 55 minutes supports 99222.
On this page
CMS RVU26D · Effective 2026-10-01
99221 Initial hospital care Medicare reimbursement rates in Virginia
Report an initial inpatient or observation evaluation when decision making is straightforward or low, or qualifying practitioner time reaches 40 minutes. Compare 99221 office and facility rates across CMS payment localities in Virginia.
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 99221 in Virginia?
Virginia has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
No supported rate
Facility setting
$72.39–$80.58
2 of 2 localities have a supported rate.
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 99221: Initial inpatient or observation care, low complexity
Report an initial inpatient or observation evaluation when decision making is straightforward or low, or qualifying practitioner time reaches 40 minutes.
This is the lowest of the three initial hospital care levels. It covers an initial evaluation during a hospital inpatient or observation stay by a physician or other qualified health professional. Hospitalists, attending physicians, and consulting specialists may use this family for their initial service, depending on services already provided by practitioners of the same specialty and group. The evaluation may include a medically appropriate history and examination and a plan for a stable, uncomplicated problem.
Select 99221 using straightforward or low medical decision making, or at least 40 minutes of qualifying practitioner time on the encounter date. Document the decision making or total time used for selection. Qualifying time can include chart review, orders, care coordination, and documentation, whether or not performed on the unit. When the same practitioner provides an office or emergency department service before admitting the patient that day, report the initial hospital service rather than a separate earlier visit. For Medicare, the admitting practitioner of record appends modifier AI to identify the admission service.
Where the value comes from
- Work RVU1.63 · 73%
- Practice expense (office) RVU0.41 · 18%
- Malpractice RVU0.19 · 9%
864.5K
Medicare services in 2024 · #157 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.
99221 compared with similar codes
Office rates for Virginia, from the same CMS release.
No office rate
99231 is for a subsequent visit after an initial service by a practitioner of the same specialty and group during the stay; 99221 is for their initial service.
No office rate
99234 covers admission and discharge on the same date at the straightforward or low level when Medicare’s eight-hour stay requirement is met. For a shorter same-date stay, report the appropriate initial hospital care code.
99252
No office rateIp/obs consltj new/est sf 35
99252 is an inpatient or observation consultation code for payers that recognize consultations when consultation requirements are met. For Medicare, select from the hospital care codes for the consultant’s initial service based on MDM or time.
Compare 99221 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.
2 of 2 payment localities
Dc + Md/Va Suburbs →
Office / nonfacility
Unavailable
Facility
$80.58
Virginia →
Office / nonfacility
Unavailable
Facility
$72.39
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99221 billing questions
When should this code be chosen instead of 99222?
Use 99221 for straightforward or low MDM, or when selecting by time and at least 40 minutes is documented. Moderate MDM or at least 55 minutes supports 99222.
Can a consultant bill this code for Medicare patients?
Yes, if this is the consultant’s initial hospital service and its MDM or time supports 99221. Medicare consultants use the initial hospital care family rather than inpatient consultation codes; the admitting practitioner of record adds modifier AI.
Is the same-day emergency department visit billable when the ED physician admits the patient?
When the same practitioner evaluates the patient in the emergency department and then admits them on the same date, report the initial hospital service rather than a separate ED visit. Include the qualifying same-day work in selecting its level.
Does this code apply to observation stays?
Yes. The initial hospital care family covers both inpatient admissions and observation stays.
Can prolonged service time be added to this level?
Medicare’s prolonged inpatient or observation service is paired with 99223, not 99221. If selecting by time, use a higher initial care level when its minimum time is met.
What documentation supports a time-based selection?
Record qualifying practitioner time on the encounter date, including activities such as reviewing results and coordinating care. Exclude time spent solely by clinical staff or on separately billed services.
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.
13,01599213,,Office o/p est low 20 min,A,,1.30,1.46,,0.33,,0.09,2.85,1.72,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01699214,,Office o/p est mod 30 min,A,,1.92,2.00,,0.47,,0.14,4.06,2.53,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,01799215,,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