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CPT 99223 — 1st hosp ip/obs high 75

CPT code 99223 (1st hosp ip/obs high 75) carries 3.5 work RVUs under the CMS 2026 Medicare Physician Fee Schedule. Total RVUs are 4.68 in a non-facility setting and 4.68 in a facility setting, which at the 2026 conversion factor of $33.40 works out to $156.32 and $156.32 respectively.

3.5
Work RVU
4.68
Total RVU (non-facility)
$156.32
Medicare, non-facility
$156.32
Medicare, facility
Calculate your total wRVUs →

RVU breakdown for CPT 99223

ComponentRVUsWhat it covers
Work RVU3.5Physician time, skill, effort, and stress.
Practice expense RVU (non-facility)0.9Office overhead, staff, supplies.
Practice expense RVU (facility)0.0Overhead when performed in a hospital.
Malpractice RVU0.28Professional liability cost.
Total RVU (non-facility)4.68Work + non-facility PE + malpractice.
Total RVU (facility)4.68Work + facility PE + malpractice.

How Medicare payment is calculated

Medicare multiplies total RVUs by the annual conversion factor. For CPT 99223 in 2026:

SettingTotal RVUConversion factorNational payment
Non-facility4.68$33.40$156.32
Facility4.68$33.40$156.32

These are national amounts. Actual payment is adjusted by the Geographic Practice Cost Index for your locality — check yours with the GPCI lookup.

Billing rules for CPT 99223

Global period
Global concept does not apply to this code.
Multiple procedure reduction
No multiple-procedure payment reduction applies.
Bilateral surgery
Bilateral adjustment does not apply.
Assistant surgeon
Not permitted unless documentation supports medical necessity.
Co-surgeon
Not permitted unless documentation supports medical necessity.
Team surgery
Not permitted unless documentation supports medical necessity.

Related codes

Codes in the same CMS family, with their work RVU values.

99202 · 0.93 wRVU99203 · 1.6 wRVU99204 · 2.6 wRVU99205 · 3.5 wRVU99211 · 0.18 wRVU99212 · 0.7 wRVU99213 · 1.3 wRVU99214 · 1.92 wRVU

Questions about CPT 99223

How many work RVUs is CPT 99223?

CPT 99223 is assigned 3.5 work RVUs in the CMS 2026 Medicare Physician Fee Schedule.

What does Medicare pay for CPT 99223?

At the 2026 national conversion factor of $33.40, CPT 99223 pays approximately $156.32 in a non-facility setting and $156.32 in a facility setting before geographic adjustment.

What is the global period for CPT 99223?

Global concept does not apply to this code.

RVU values reflect the CMS 2026 Medicare Physician Fee Schedule (conversion factor $33.40). Payment figures are national and unadjusted for geography. Verify against the official fee schedule before using for billing.