# CPT 99223

> Medicare paid $204.87 for CPT 99223 in the office (non-facility) setting and $204.87 in a facility under the Q3 2015 Physician Fee Schedule, effective July 2015. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2015, when it increased 0.3%.

## What it is

The first physician visit of a hospital or observation admission at the highest level — for example, admitting a patient with sepsis or a GI bleed, a condition posing a significant threat to life. Documentation should reflect extensive data review and high risk from the condition or its management; total time typically runs about 75 minutes. It is the top-level admitting visit.

## Selected release

- Release: Q3 2015 (2015 C)
- Effective: July 1 – September 30, 2015
- Status indicator: A
- Office (non-facility) national allowed amount: $204.87
- Facility national allowed amount: $204.87
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.86
- Office (non-facility) practice expense RVU: 1.57
- Facility practice expense RVU: 1.57
- Malpractice RVU: 0.30
- Conversion factor: 35.7547
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q3 2015)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu15c.zip
- Parsed file: PPRRVU15_UP0.V0515.csv, row 15,939
- Canonical page: https://localishealth.com/cpt/99223/2015/A
- Release-specific citation URL: https://localishealth.com/cpt/99223/2015/C
- Last significant update: 2026-08-04T03:06:00+00:00