Hospital · CMS status A
99221
Initial hospital inpt/obs sf 40 min
Initial hospital inpatient or observation care, per day, low-level medical decision making or 40 minutes of total time on the date of the encounter. CMS 2026 wRVU 1.63. Used by hospitalists, admitting providers, and consultants on the first day of admission.
Work RVU
1.63
2026 Medicare pays
$80.83
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 1.63 + Practice 0.66 + Malpractice 0.13 = 2.42 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99221 is locked
- When to use it: the exact clinical situations that support billing 99221
- Documentation checklist: the 4 elements your note needs before submitting
- Common pitfalls: the 3 mistakes that get 99221 downcoded or denied
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Common modifiers
AI (principal physician of record)25
Common ICD-10 pairings
I10E11.9N39.0J18.9
Payer notes
Medicare requires modifier AI on the principal physician's initial admission claim when consultants are also billing 99221-99223. Commercial payers vary on whether consultants should code as initial-care (99221-99223) or inpatient-consult (99252-99255); follow each payer's policy.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.