How much does Medicare pay for CPT 99233?

Medicare allowed an average of $115.58 per service and paid $91.49 of that, the balance being the patient's coinsurance and deductible (2024 data). Providers submitted an average of $325.51, which is what they billed rather than what they received — Medicare pays its fee schedule regardless of the charge.

What is CPT code 99233?

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes. It was billed 22,309,090 times to 9,317,705 Medicare beneficiaries by 131,573 providers in 2024.

Does 99233 pay differently in an office than a hospital?

Yes. The allowed amount averaged $109.48 in an office setting and $115.59 in a facility. The office rate is generally higher because the practice supplies the room, staff and equipment out of that single payment; in a hospital those are billed separately by the facility.

Which specialty bills 99233 most?

Internal Medicine, with 7,176,503 services from 31,752 clinicians. Next are Hospitalist, Nephrology, Nurse Practitioner.

CPT 99233

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes

$115.58Medicare-allowed amount per service, averaged across 22,309,090 services

Providers submitted

$325.51

Asking price, not received

Medicare allowed

$115.58

The fee schedule figure

Medicare paid

$91.49

Balance is patient coinsurance

Providers submitted an average of $325.51 for this code and Medicare allowed $115.58 — 2.8× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $91.49 (79%); the rest is the patient’s coinsurance and deductible.

Office pays differently to hospital

Office / non-facility: $109.48
Hospital / facility: $115.59

The facility rate is higher for this code, which is unusual and generally means the service depends on equipment or staffing a hospital carries. 28,462 services were billed in an office setting and 22,280,628 in a facility.

Services: 22,309,090
Beneficiaries: 9,317,705
Providers billing it: 131,573
Total allowed: $2,578,484,622

What Medicare pays for CPT 99233

Across 22,309,090 services billed by 131,573 providers to 9,317,705 beneficiaries, Medicare allowed an average of $115.58 per service. That is 2.4 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

Who bills 99233

Specialty	Services	Beneficiaries	Avg allowed	Providers
Internal Medicine	7,176,503	2,882,690	$116.71	31,752
Hospitalist	3,203,580	1,414,075	$117.37	14,779
Nephrology	1,569,841	554,992	$117.01	6,632
Nurse Practitioner	1,346,980	658,041	$98.31	13,457
Pulmonary Disease	1,304,608	513,631	$116.90	6,689
Cardiology	1,201,040	542,531	$118.82	8,940
Infectious Disease	1,120,822	420,516	$117.54	4,453
Family Practice	1,087,670	443,237	$115.25	5,895
Physical Medicine and Rehabilitation	546,673	217,895	$115.83	1,884
Physician Assistant	480,547	245,704	$98.44	5,479
Neurology	444,008	225,760	$117.69	4,048
Hematology-Oncology	386,201	136,274	$119.30	3,474
Critical Care (Intensivists)	359,359	171,684	$117.66	2,972
Interventional Cardiology	308,470	150,977	$117.31	2,400
Psychiatry	289,002	86,209	$116.64	2,327

99233 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

State	Services	Allowed	Standardized pmt	Providers
California	3,224,494	$120.80	$90.57	11,937
Florida	2,162,835	$116.25	$89.78	10,252
Texas	1,951,623	$112.46	$89.67	9,649
New York	1,322,177	$125.39	$90.29	8,734
Illinois	1,198,684	$118.64	$90.09	6,061
New Jersey	1,006,243	$122.01	$90.17	4,398
Pennsylvania	880,277	$113.79	$89.45	6,697
Ohio	727,626	$110.58	$89.19	5,904
Arizona	618,564	$112.08	$90.15	2,720
Georgia	600,665	$112.70	$89.80	3,977
Massachusetts	577,202	$118.49	$89.20	4,372
Michigan	547,211	$115.66	$89.96	4,243
Maryland	512,832	$118.54	$89.22	2,775
North Carolina	511,126	$109.61	$88.94	4,366
Virginia	510,438	$115.25	$89.71	3,281
Indiana	409,302	$108.44	$89.89	2,704
Tennessee	409,057	$108.05	$89.60	2,689
Nevada	368,317	$111.55	$89.37	1,178
Missouri	350,180	$111.39	$90.01	2,647
Kentucky	297,510	$110.99	$89.64	1,843
Alabama	278,543	$107.43	$90.01	1,836
Washington	277,675	$117.06	$89.47	2,416
Louisiana	275,975	$109.84	$89.32	1,967
Oklahoma	274,348	$108.62	$89.30	1,275
South Carolina	241,666	$110.81	$89.68	1,903
Minnesota	240,899	$109.96	$88.88	2,560
Mississippi	230,685	$107.93	$89.58	973
Colorado	229,593	$114.48	$89.60	1,954
Kansas	219,234	$109.23	$90.17	1,128
Wisconsin	212,098	$108.32	$89.48	2,133
Arkansas	198,274	$106.78	$90.29	951
Connecticut	174,523	$119.84	$89.38	1,740
Oregon	138,739	$114.99	$89.35	1,345
District of Columbia	114,986	$125.23	$90.16	679
Iowa	111,123	$108.68	$89.84	880
Nebraska	108,268	$106.80	$89.72	794
West Virginia	90,412	$112.49	$89.91	722
Delaware	83,505	$114.40	$90.10	514
New Hampshire	75,377	$113.77	$89.36	601
Utah	68,318	$110.56	$89.07	724
New Mexico	67,888	$110.00	$87.80	552
Hawaii	58,544	$115.61	$90.33	345
Maine	51,956	$113.62	$89.20	604
Rhode Island	49,847	$116.32	$89.23	475
Idaho	47,251	$108.29	$90.00	401
Montana	40,024	$112.98	$88.48	375
South Dakota	36,227	$110.42	$90.15	274
North Dakota	33,429	$111.20	$89.66	281
Alaska	29,711	$148.71	$90.13	190
Vermont	23,035	$111.96	$89.13	236
Puerto Rico	17,283	$110.77	$90.93	170
Wyoming	14,063	$112.01	$88.98	110
Guam	5,925	$112.96	$86.12	20
U.S. Virgin Islands	1,113	$111.68	$90.93	5
ZZ	996	$112.20	$89.12	6
AP	486	$126.44	$91.23	2

Related codes

99214Established patient office or other outpatient visit$117.48
99213Established patient office or other outpatient visit$83.92
99232Subsequent hospital care$76.07
99215Established patient office or other outpatient visit$163.65
99204New patient office or other outpatient visit$157.90
99223Initial hospital care$167.67
99285Emergency department visit$169.68
99203New patient office or other outpatient visit$104.03
99212Established patient office or other outpatient visit$52.42
99291Critical care$208.35
99222Initial hospital care$126.29
99239Hospital discharge day management$110.50

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.