Reimbursement
$116.57
Threshold
55m
2026 Status
Active
What is CPT Code 99222?
CPT 99222 is defined as: Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and moderate level medical decision making. Typically involves patients with multiple chronic conditions and acute exacerbations.
This code is primarily used for E/M services. It falls under the category of Hospital Inpatient/Observation & Emergency Department and is valid for the 2026 calendar year according to the CMS Physician Fee Schedule.
2026 RVU Components
Relative Value Units (Non-Facility)
Work RVU
2.6
Physician Effort
PE (Non-Fac)
0.67
Practice Expense
Malpractice
0.22
Risk Factor
Total RVU
3.49
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
productivity focus
99222 is a high-volume hospital code; CMS maintains stable RVUs to support hospitalist labor costs.
efficiency shield
Exempt from -2.5% efficiency cut.
facility differential
PE value reflects high resource utilization in a facility setting compared to 99221.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Key Modifiers
Operational Requirements
minimum time
55 minutes (if billing by time)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Once per admission per specialty
add on codes
care plan requirement
Moderate medical decision making typically involving multiple stable illnesses or one acute illness with systemic symptoms.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Auditors are focusing on 'Diagnosis Management' – ensure the assessment clearly lists all conditions being managed.
Common Clinical Scenarios
CMS Eligibility: 2+ stable chronic illnesses or 1 new acute illness with systemic symptoms. Admission day
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99221
99221 is low MDM (40m); 99222 is moderate MDM (55m).
VS 99223
99223 is high MDM (75m).
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