CPT 99223
Global XXX Active1st hosp ip/obs high 75
CPT 99223 Billing & Documentation Guide
CPT code 99223 (1st hosp ip/obs high 75) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 3.5, a non-facility practice expense RVU of 0.9, and a malpractice RVU of 0.28, a total non-facility RVU of 4.68 and facility RVU of 4.68. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $158.67, though rates vary from $147.54 to $212.52 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99223, 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 99223 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 99223 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 99223
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 3.5 | 3.5 |
| Practice Expense RVU | 0.9 | 0.9 |
| Malpractice RVU | 0.28 | 0.28 |
| Total RVU | 4.68 | 4.68 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99223
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 | $161.73 | $161.73 | $156.85 - $178.12 | 29 |
| Florida | $165.27 | $165.27 | $159.7 - $171.85 | 3 |
| Georgia | $156.95 | $156.95 | $154.87 - $159.03 | 2 |
| Illinois | $164.23 | $164.23 | $158.97 - $169.4 | 4 |
| Michigan | $158.3 | $158.3 | $154.91 - $161.68 | 2 |
| North Carolina | $150.93 | $150.93 | $150.93 - $150.93 | 1 |
| New York | $168.7 | $168.7 | $152.04 - $177.49 | 5 |
| Ohio | $153.78 | $153.78 | $153.78 - $153.78 | 1 |
| Pennsylvania | $157.4 | $157.4 | $153.34 - $161.46 | 2 |
| Texas | $155.83 | $155.83 | $152.95 - $160.56 | 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 99223
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99223 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 99223
What does CPT code 99223 mean? +
CPT code 99223 represents: 1st hosp ip/obs high 75. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99223? +
The 2026 Medicare national average non-facility payment for CPT 99223 is $158.67. Rates range from $147.54 to $212.52 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99223? +
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 99223? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
Get the full PayerReady toolkit
Free access to CPT/ICD-10 lookup, denial appeals, fee comparator, and claim auditing with credentialing enrollment.
Start free →Run this code through our claim audit tool
Check NCCI bundling, MUE limits, and modifier logic before submission.
Try the auditor →Did this page help?
Quick signal so we know what to improve.
If you want a code reference page that doesn't exist yet, email coding@payerready.com.
Tell us what's missing or wrong: coding@payerready.com. We respond within 5 business days.
Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
Powered by 11K CPT · 98K ICD-10 · 860K MPFS rates · 4.5M NCCI edits · 9.5M NPIs. Our data methodology · About our coding team