Evaluation & management · General
Follow-up hospital inpatient or observation visit with high medical decision making, or at least 50 minutes of total time on the date.
- Medicare
- $106.88
- Work RVU
- 2.4
- Global, days
- Region
- General
Documentation requirements
What must appear in the operative or office note to support the claim.
Source · Editorial brief grounded in 3 cited references ↓
- Interval history and changes since the last visit
- Focused exam
- Assessment and plan supporting high MDM, or total time
- If in a global period, the unrelated diagnosis and why it is unrelated
- Data reviewed that day, such as new imaging or labs
Applicable modifiers
Modifiers commonly billed with this code.
Source · AMA CPT modifier descriptors · CMS NCCI Policy Manual
What this code covers
Source · Editorial summary grounded in 3 cited references ↓
99233 is a follow-up hospital inpatient or observation visit with high decision making, or at least 50 minutes of total time on the date. It fits a patient who is unstable or getting worse, such as a new compartment syndrome concern, a significant drop in hemoglobin, or a decision about urgent return to surgery.
The global period is where orthopedic surgeons get caught. Daily rounding after a hip, knee, or spine surgery is included in the 90-day global payment. Those visits are not billable. Bill a subsequent hospital visit only when the work is for a problem unrelated to the surgery (modifier 24), or for a complication that needs a return to the OR, which is billed as the procedure instead.
Non-operative patients need a decision up front. If the orthopedist bills a closed treatment code for, say, a pelvic ring fracture, that code has its own 90-day global and the daily visits fall inside it. If no fracture care code is billed, each day's visit is billed at the level the note supports.
RVU & reimbursement
Component RVUs and Medicare national rate. Actual payment varies by GPCI locality.
Source · CMS Physician Fee Schedule, RVU26A · January 2026
Work RVU vs. total RVU
The work RVU (2.4) is the surgeon's own effort — the figure physician pay and productivity targets are built on. The total RVU (3.2) adds practice overhead and malpractice, and is what drives the Medicare payment below.
| Work RVU | 2.4 |
| Practice expense RVU | 0.62 |
| Malpractice RVU | 0.18 |
| Total RVU | 3.2 |
| Medicare national rate | $106.88 |
| Global period | days |
Payment by site of service
Medicare pays different rates by setting. HOPD typically pays substantially more than ASC for the same procedure.
Source · CMS OPPS Addendum B·ASC HCPCS payment rates·2026
| Setting | Medicare rate (national) |
|---|---|
Office (PFS non-facility) Procedure performed in physician's office | $106.88 |
Common denial reasons
The recurring reasons claims for CPT 99233 get rejected.
Source · Editorial brief grounded in CMS NCCI edits, AAOS coding appeals, and cited references ↓
- Postop rounding billed inside the 90-day global
- Modifier 24 used but diagnosis ties back to the surgery
- Note supports a lower level than high MDM
- Same-specialty partners both billing on the same day
Frequently asked questions
Source · Generated from the editorial pipeline, verified against 3 cited references ↓
01When is 99233 justified?
02Can 99233 be billed for a postop complication?
03Can 99233 be billed the day before a new major surgery?
04Why was 99233 downcoded to 99232?
Sources & references
Editorial content was developed using the following public sources.
Mira Scribe
Mira Scribe captures the day's changes, data reviewed, and decision making, which makes it straightforward to support high MDM and to show when a visit is unrelated to the surgery.
See how Mira captures CPT 99233 documentation