Reimbursement
$60.12
Threshold
35m
2026 Status
Active
What is CPT Code 99232?
CPT 99232 is defined as: Subsequent 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 stable patients with new problems or those improving from severe illness.
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
1.3
Physician Effort
PE (Non-Fac)
0.4
Practice Expense
Malpractice
0.1
Risk Factor
Total RVU
1.8
Note: [(Work RVU * Work GPCI) + (PE RVU * PE GPCI) + (MP RVU * MP GPCI)] * Conversion Factor
2026 CMS Policy Intelligence
hospital productivity
Maintains a work RVU of 1.3, making it the most common 'workhorse' code for inpatient rounding.
efficiency shield
Exempt from -2.5% efficiency cut.
observation parity
Equally applicable to observation stays lasting multiple days.
Administrative Framework
Global Period
000
Place of Service
NCCI Exclusions
Operational Requirements
minimum time
35 minutes (if billing by time)
staff type
Physician or other Qualified Health Care Professional (QHP)
frequency
Once per day per specialty
add on codes
care plan requirement
Documentation of moderate MDM: management of 2+ stable illnesses or 1 acute illness with systemic symptoms.
Compliance Checklist
Audit Defense
No specific audit defense elements defined.
2026 Update
Medicare is monitoring total time for hospitalists routinely billing 99232/99233 for every patient in a large wing.
Common Clinical Scenarios
CMS Eligibility: 2+ stable chronic conditions or 1 acute worsening. Stay management
Target Specialties & Utilization
Typical Clinical Indications (ICD-10)
Billing Differentiation
VS 99231
99231 is for low MDM (25m); 99232 is for moderate MDM (35m).
VS 99233
99233 is for high MDM (50m).
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