PFS ExplorerMedicare Physician Fee Schedule · 2026

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99231

Sbsq hosp ip/obs sf/low 25

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Code typePrimary
Payment statusActive (A)
Global periodNone

Pricing with Related Codes

Line
Qty
Global fee
Pro fee
Primary99231Sbsq hosp ip/obs sf/low 25
1
$44.09
$44.09
Add-on90833Psytx w pt w e/m 30 min
0
$81.50/ unit
$65.80/ unit
Add-on90836Psytx w pt w e/m 45 min
0
$103.21/ unit
$83.17/ unit
Add-on90838Psytx w pt w e/m 60 min
0
$136.61/ unit
$110.22/ unit
Add-on96160Pt-focused hlth risk assmt
0
$3.01/ unit
$3.01/ unit
Add-on96161Caregiver health risk assmt
0
$3.34/ unit
$3.34/ unit
Add-onG0506Comp asses care plan ccm svc
0
$66.47/ unit
$38.41/ unit
Add-onG0545Inherent visit to inpt
0
$48.43/ unit
$40.42/ unit
Whole procedure · 1.00 wRVU credited
$44.09
$44.09

RVU Breakdown

Component
Office
Facility
Work
1.00
1.00
Practice expense
0.24
0.24
Malpractice
0.08
0.08
Total RVU
1.32
1.32

Payment Policy & Modifiers

Allowed adjustments
Assistant surgeon -80/81/8216% · documented
Assistant at surgery (mod 80/81/82) paid at 16% if medical necessity is documented.
Not applicable to this code
Bilateral -50Multiple procedure Co-surgeon -62Team surgeon -66Prof / tech split