CPT 99223
Initial hospital care, high complexity
The admitting doctor's charge for the first day of an inpatient stay at the highest complexity level. The lower levels are 99221 and 99222. Since 2023 the same codes are used for observation stays.
Billed to Medicare
$559
What providers submitted, on average, for this code in an office.
Medicare accepted
$166
What Medicare treated as payable. Not a commercial rate or a cash price.
The gap
3.4x
How many times the accepted amount the billed figure was.
National averages from the Centers for Medicare & Medicaid Services, 2024 data, retrieved 2026-09-14. Medicare fee-for-service, physician and practitioner claims only. The hospital's own charge for the same code is separate and is usually higher. Based on 26,325 services.
Of the 4 doctor visits codes on this site with CMS figures, this one has the widest gap between what is billed and what Medicare accepts. The narrowest is Office visit, established patient, level 3 at 2.2x.
Where this line goes wrong
One admitting doctor
Only the admitting physician bills initial hospital care. Other doctors who saw you on day one bill consultations or subsequent care. Two initial care codes for the same day from two doctors is worth a question.
ER visit plus admission by the same doctor
If the same physician saw you in the ER and admitted you, only the admission is billed. An ER level and 99223 from the same doctor on the same day is a duplicate.
Check it, then ask
- 1
Check which doctors billed on the admission day and what each billed.
- 2
If the ER doctor also admitted you, check for both an ER level and an admission code from that doctor.
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Codes that travel with this one
People also ask
Why is there a doctor's charge for the day I was admitted as well as the hospital's charge?
The hospital bills for the bed and the care. The admitting doctor bills for evaluating you and writing the plan. Both are normal.
Sources
This page explains a billing code in general terms. It is not a coding, legal or medical opinion about your bill, and the code descriptions are mediloop's own plain-English summaries, not the official CPT descriptors, which are owned by the American Medical Association. Whether a charge was correct depends on the record of your visit and your payer's rules.