CPT 99222
Global XXX Active1st hosp ip/obs moderate 55
CPT 99222 Billing & Documentation Guide
CPT code 99222 (1st hosp ip/obs moderate 55) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 2.6, a non-facility practice expense RVU of 0.67, and a malpractice RVU of 0.23, a total non-facility RVU of 3.5 and facility RVU of 3.5. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $118.55, though rates vary from $110.02 to $158.33 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99222, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99222 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99222 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99222
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 2.6 | 2.6 |
| Practice Expense RVU | 0.67 | 0.67 |
| Malpractice RVU | 0.23 | 0.23 |
| Total RVU | 3.5 | 3.5 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99222
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $120.6 | $120.6 | $116.96 - $132.78 | 29 |
| Florida | $124.25 | $124.25 | $119.78 - $129.57 | 3 |
| Georgia | $117.51 | $117.51 | $115.96 - $119.07 | 2 |
| Illinois | $123.45 | $123.45 | $119.28 - $127.57 | 4 |
| Michigan | $118.67 | $118.67 | $115.95 - $121.39 | 2 |
| North Carolina | $112.63 | $112.63 | $112.63 - $112.63 | 1 |
| New York | $126.37 | $126.37 | $113.5 - $133.27 | 5 |
| Ohio | $115.02 | $115.02 | $115.02 - $115.02 | 1 |
| Pennsylvania | $117.76 | $117.76 | $114.65 - $120.87 | 2 |
| Texas | $116.49 | $116.49 | $114.34 - $120.33 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99222
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99222 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0074T | Column 1 (primary), can be billed with modifier | 9 | CPT Manual or CMS manual coding instruction |
| 0115T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0116T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0359T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0360T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0361T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0363T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0364T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
Frequently Asked Questions, CPT 99222
What does CPT code 99222 mean? +
CPT code 99222 represents: 1st hosp ip/obs moderate 55. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99222? +
The 2026 Medicare national average non-facility payment for CPT 99222 is $118.55. Rates range from $110.02 to $158.33 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99222? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99222? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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