Hospital · CMS status A
99222
Initial hospital inpt/obs mod 55
Initial hospital inpatient or observation care, per day, moderate-level medical decision making or 55 minutes of total time on the date of the encounter. CMS 2026 wRVU 2.60. The most common initial-day code in adult hospital medicine.
Work RVU
2.60
2026 Medicare pays
$128.59
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 2.60 + Practice 1.05 + Malpractice 0.20 = 3.85 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99222 is locked
- When to use it: the exact clinical situations that support billing 99222
- Documentation checklist: the 4 elements your note needs before submitting
- Common pitfalls: the 4 mistakes that get 99222 downcoded or denied
Start your free 3-month trial →Every new account gets full Pro Max access for 3 months. No card needed.
Common modifiers
AI25
Common ICD-10 pairings
J44.1I50.32L03.115K57.32N39.0
Payer notes
Medicare and Medicare Advantage plans pay 99222 at the standard PFS allowable. Commercial payers usually mirror Medicare's rate. Some payers audit 99222-to-99223 ratios at the practice level. The AI modifier is Medicare-specific.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.