CMS 2023 data Official source Free · public domain

Hospital Visit

16 procedures in Hospital Visit. Medicare reimbursement averages $166.87 per service; billed charges average N/A. Source: CMS Medicare Physician & Other Practitioners 2023.

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Where this category sits

Among CMS procedure categories, Hospital Visit ranks #30 of 73 by average Medicare payment ($166.87 per service across its 16 procedure codes).

#30
of 73 categories by avg payment
$166.87
avg Medicare payment
16
procedure codes

Category placement is ordered by average Medicare payment per service, descending, among all published procedure categories.

Inpatient hospital visits for evaluation and management

16 procedures · Avg Medicare payment: $166.87

Code Procedure Medicare Billed
99232 Subsequent Hospital Care With Moderate Levelof Medical Decision Making, If Using Time, At Least 35 Minutes $61.56 $197.37
99233 Subsequent Hospital Care With Moderate Levelof Medical Decision Making, If Using Time, At Least 50 Minutes $93.53 $305.58
99223 Initial Hospital Care With Moderate Level Of Medical Decision Making, If Using Time, At Least 75 Minutes $133.55 $556.02
99222 Initial Hospital Care With Straightforward Or Low-Level Medical Decision Making, If Using Time, At Least 55 Minutes $99.68 $365.21
99239 Hospital Discharge Day Management, More Than 30 Minutes $88.54 $337.76
99231 Subsequent Hospital Care With Straightforward Or Low Level Of Medical Decision Making, Per Day, If Using Time, At Least 25 Minutes $37.76 $114.23
99238 Hospital Discharge Day Management, 30 Minutes Or Less $61.95 $212.93
99221 Initial Hospital Care With Straightforward Or Low Level Of Medical Decision Making, Per Day, If Using Time, At Least 40 Minutes $62.62 $278.86
99236 Initial Hospital Care With Same-Day Admission And Discharge With High Level Of Medical Decision Making, Per Day, If Using Time, At Least 85 Minutes $157.08 $768.18
99235 Initial Hospital Care With Same-Day Admission And Discharge With Moderate Level Of Medical Decision Making, Per Day, If Using Time, At Least 70 Minutes $118.22 $474.56
99234 Initial Hospital Care With Same-Day Admission And Discharge With Straightforward Or Low Level Of Medical Decision Making, Per Day, If Using Time, At Least 45 Minutes $74.06 $339.26
99476 Follow-Up Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) $266.44 $1,151.88
99472 Follow-Up Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (29 Days To 2 Years) $311.53 $1,323.85
99475 Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (2-5 Years) $435.94 $1,880.53
99471 Initial Inpatient Hospital Critical Care Of Infant Or Young Child Per Day (29 Days To 2 Years) $576.17 $2,982.04
99463 Initial Inpatient Hospital Or Birthing Center Same Date Care And Discharge Of Newborn $91.30 $388.31

Reading Hospital Visit Pricing Data

The 16 procedure codes grouped under Hospital Visit share a common clinical taxonomy in the CMS Medicare Physician & Other Practitioners dataset. Across this category, the average Medicare payment is $166.87 - the figure Medicare actually reimburses providers for the allowed amount after geographic and specialty adjustments. Inpatient hospital visits for evaluation and management Each CPT/HCPCS code in the table above carries its own fee schedule value determined by CMS's Resource-Based Relative Value Scale (RBRVS), which weights physician work, practice expense, and professional liability.

Billed charges, the "Billed" column, often run several multiples above Medicare allowed amounts. This is expected under US chargemaster pricing practices: providers list a gross rate, then accept negotiated write-offs from Medicare, Medicaid, and commercial insurers under participation agreements. A high markup ratio does not necessarily indicate overcharging, because almost no payer pays the full billed charge. However, uninsured and out-of-network patients can be exposed to amounts closer to the billed rate, which is why federal rules now require providers to publish cash and negotiated prices through the Hospital Price Transparency initiative.

Volume matters when interpreting category-level data. Procedures with millions of annual services, evaluation visits, common diagnostic work, reflect stable, well-benchmarked pricing. Lower-volume codes may show wider variation across providers and settings because small sample sizes produce less stable averages. When comparing specific procedures, drill into the individual procedure page for state-level breakdowns, provider counts, and commercial pricing estimates derived from RAND 2024 research. This page presents CMS reference data for educational use; it does not constitute medical, legal, or financial advice.

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Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure  · Verify with CMS →

Disclaimer: This information is provided for informational purposes only and does not constitute professional advice. Data is sourced from CMS (Centers for Medicare and Medicaid Services). Consult a qualified professional before making decisions based on this data.

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Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.