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 in New York
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
New York Pricing in Context
In New York, CPT code 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) carries an average Medicare payment of $126.77 — 7% above the national benchmark of $118.22. 1.7K providers across the state submitted claims for this procedure in 2023, performing 4.5K total services. Individual payments in NY ranged from N/A at the low end to N/A at the high end, reflecting differences in provider setting (office vs. facility), modifiers, and the specific geographic locality code applied within the state.
The average billed charge in New York is $578.92, which is the figure uninsured patients would most likely encounter before any negotiation or charity discount. Medicare, by statute, only reimburses the allowed amount — the balance between billed and paid is written off under provider participation agreements. Insured patients generally pay a negotiated rate that falls between these two figures; the exact amount depends on plan design, deductible status, and in-network participation. Because New York sits above the national Medicare average, commercial rates in the state may also run higher than the US median.
Using RAND 2024 commercial-to-Medicare ratios for Hospital Visit procedures, the estimated commercial insurance price in New York lands near $413.00, with self-pay cash prices typically around $283.11. Before scheduling, patients can request a Good Faith Estimate under the No Surprises Act, compare cash rates from hospital Machine-Readable Files, and confirm whether the provider is in-network with their specific plan. This page presents CMS reference data for informational use; it does not constitute medical or financial advice.
Frequently Asked Questions
How much does 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 cost in New York?
The average Medicare payment for 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 in New York is $126.77, which is 7% above the national average of $118.22. Providers in NY typically bill $578.92 for this procedure.
What does 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 cost with insurance in New York?
With commercial insurance in New York, 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 costs an estimated $413.00. Without insurance, the estimated cash price is $283.11. These estimates are based on RAND 2024 commercial-to-Medicare ratios and vary by insurer, plan, and facility.
How many providers perform 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 in New York?
1.7K providers in New York billed Medicare for 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 in 2023, performing 4.5K total services. Medicare payments ranged from N/A to N/A depending on the provider.
Is 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 cheaper in New York than the national average?
No — 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 costs 7% above the national average in New York. The state average Medicare payment is $126.77 compared to $118.22 nationally. Factors like local cost of living, provider competition, and regional Medicare fee schedules all influence state-level pricing.
Related Guides
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.