Hospital · CMS status A
99231
Subseq hosp inpt/obs sf 25 min
Subsequent hospital inpatient or observation care, per day, low-level medical decision making or 25 minutes of total time. CMS 2026 wRVU 0.76. Lowest of the three subsequent-care codes; used when the patient is stable and the day's work is observation only.
Work RVU
0.76
2026 Medicare pays
$37.41
National GPCI · non-facility · CF $33.4009
RVU anatomyWork 0.76 + Practice 0.30 + Malpractice 0.06 = 1.12 total
Work (your effort)Practice expenseMalpractice
Billing guidance for 99231 is locked
- When to use it: the exact clinical situations that support billing 99231
- Documentation checklist: the 3 elements your note needs before submitting
- Common pitfalls: the 2 mistakes that get 99231 downcoded or denied
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Common modifiers
25
Common ICD-10 pairings
I10E11.9Z51.5
Payer notes
Medicare and commercial payers pay 99231 at the standard PFS allowable. Use this code conservatively; routine post-op days and observation-only days are the typical use case.
Pairs well with
Educational reference, not billing or legal advice. Verify against your payer contracts and your compliance team before submission.