# CPT 99231

> The national PFS baseline is $44.09 for CPT 99231 in the office (non-facility) setting and $44.09 in a facility under the Q3 2026 Physician Fee Schedule, effective July 2026. These are the national allowed amounts before locality (GPCI) adjustment; sequestration is excluded. Across payment localities, both settings' amount is $41.66–$60.11. This price has been unchanged since Q1 2026, when it decreased 6.6%.

## What it is

Subsequent Hospital Care, Level 1

## Selected release

- Release: Q3 2026 (2026 C)
- Effective: July 1 – September 30, 2026
- Status indicator: A
- Office (non-facility) national allowed amount: $44.09
- Facility national allowed amount: $44.09
- Sequestration: not applied

## RVUs and formula

- Work RVU: 1.00
- Office (non-facility) practice expense RVU: 0.24
- Facility practice expense RVU: 0.24
- Malpractice RVU: 0.08
- Conversion factor: 33.4009
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## NCCI edits

- Never-billable pair count: 416
- Modifier-allowed pair count: 5879
- MUE units per patient per date of service: not published
- Complete list: https://localishealth.com/cpt/99231/ncci-edits.txt

## Source and citation

- Source: Physician relative value file (Q3 2026)
- CMS file: https://www.cms.gov/files/zip/rvu26c-updated-06-30-2026.zip
- Parsed file: PPRRVU2026_Jul_nonQPP.csv, row 12,960
- Canonical page: https://localishealth.com/cpt/99231
- Release-specific citation URL: https://localishealth.com/cpt/99231/2026/C
- Last significant update: 2026-08-13T15:11:57+00:00