CPT Code 99222 is an important inpatient evaluation and management (E/M) service. Used by physicians and qualified healthcare professionals. As the initial hospital care code in the middle complexity level, 99222 is used.
When a provider performs a medically necessary visit that requires a detailed history, detailed examination, and reasonable medical decision making (MDM).
What does this code mean? How it is used and why it plays an important role in inpatient documentation and billing.
The CPT Code 99222 description includes a detailed patient evaluation at the time of admission or initial inpatient encounter. This code meets the moderate-complexity level for a new or established patient.
99222 CPT Code Descriptions
According to E/M guidelines, CPT 99222 includes:
This time includes face-to-face time, chart review, care coordination, and documentation.
CPT Code 99222 is used when a provider admits a patient or evaluates them during an initial inpatient or observation visit, and the case complexity meets moderate MDM criteria.
Common uses include:
CPT Code 99222 is a strict inpatient or observation service code. It cannot be used for outpatient or office visits.
For comparison:
Code | Setting | MDM Level | Typical Time |
Inpatient | Straightforward/Low | 40 min | |
99222 | Inpatient | Moderate | 55 min |
99223 | Inpatient | High | 75 min |
99242 / 99243 | Outpatient consults | Low–Moderate | N/A |
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Feature | 99221 | 99222 |
History | Problem-focused or detailed | Detailed |
Exam | Problem-focused or detailed | Detailed |
MDM | Straightforward/Low | Moderate |
Time | 40 minutes | 55 minutes |
Visit Severity | Low | Moderate |
Reimbursement depends on payer, location, and contracted rates.
Typical Medicare National Average
Factors Affecting Payment
CPT Code 99222 is billed with one of the following:
POS Code | Meaning | Allowed for 99222? |
21 | Inpatient Hospital | Yes |
22 | Outpatient Hospital | Yes (Observation) |
23 | Emergency Room | Yes (if admitted/observed) |
02 | No (not an outpatient code) | |
11 | Office | No |
Can CPT Code 99222 Be Billed With POS 22?
Yes, POS 22 (outpatient hospital) is valid for observation-level initial services.
Can CPT Code 99222 Be Billed With POS 23?
Yes, only if the patient is admitted or placed into observation status.
Most of the time, 99222 does NOT require modifiers. However, modifiers may be used in certain cases:
Modifier | When to Use |
25 | Significant, separately identifiable E/M on the same day |
AI | Principal physician of record |
95 / GT | Telehealth (NOT applicable to 99222) |
59 | Different procedural service (rare for E/M) |
51 | Multiple procedures (rare for E/M) |
76 / 77 | Repeat service by the same/different provider |
79 | Unrelated service during the global period |
GV | Hospice patient – attending physician |
TH | OB maternal services (rare but possible) |
To bill CPT Code 99222, the provider must meet:
Required Elements
Documentation Must Include
Billing steps:
ICD-10-CM Code for CPT 99222
There is no specific ICD-10-CM code for 99222.
Diagnosis codes depend on the patient condition.
Examples:
Most systems include 99222 by default:
EHRs
Billing Software
Billing Companies Handling 99222
They handle verification, coding, claims submission, and denial management.
Accurate use of CPT Code 99222 makes sure that proper reimbursement. Compliance and a smooth inpatient workflow. By supporting thoroughly, choose the correct POS and apply the modifiers only. When appropriate, providers can reduce denials and ensure faster payment.
If you want help to improve your inpatient billing accuracy. Optimize E/M compliance or reduce claim denials. Our team can support you with expert coding guidance and complete RCM services.
Need expert medical billing support? Contact us today to simplify your inpatient coding and increase your reimbursement.
Related Time Questions
Include detailed history, detailed exam, moderate MDM, and medically necessary justification.
Outpatient Coding
Inpatient Coding
This difference is why office/outpatient established low MDM codes (99212–99214) do not overlap with inpatient codes like 99222.
CPT code 99222 corresponds to 55 minutes of total provider time on the date of the encounter. According to AMA 2024–2025 E/M guidelines. These minutes include pre-visit review the face-to-face exam and post-visit documentation performed by the billing provider.
While time is one way to support 99222 you can also bill it based on moderate medical decision-making (MDM). If the clinical visit meets those criteria.
Modifiers for CPT code 99222 depend on the clinical situation and payer rules. Commonly used modifiers include:
There is no default modifier required for 99222 modifiers are only applied. When necessary based on documentation and payer requirements.
Yes, Medicare reimburses 99222. When documentation meets guidelines.
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