# CPT 99223

> Medicare paid $206.64 for CPT 99223 in the office (non-facility) setting and $206.64 in a facility under the Q2 2018 Physician Fee Schedule, effective April 2018. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2018, when it increased 0.5%.

## 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: Q2 2018 (2018 B)
- Effective: April 1 – June 30, 2018
- Status indicator: A
- Office (non-facility) national allowed amount: $206.64
- Facility national allowed amount: $206.64
- Sequestration: not applied

## RVUs and formula

- Work RVU: 3.86
- Office (non-facility) practice expense RVU: 1.59
- Facility practice expense RVU: 1.59
- Malpractice RVU: 0.29
- Conversion factor: 35.9996
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q2 2018)
- CMS file: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeesched/downloads/rvu18b.zip
- Parsed file: PPRRVU18_APR.csv, row 16,500
- Canonical page: https://localishealth.com/cpt/99223/2018/A
- Release-specific citation URL: https://localishealth.com/cpt/99223/2018/B
- Last significant update: 2026-08-04T03:08:19+00:00