99231

🎯 CPT Code 99231 Documentation & Billing Guide

Last Updated: February 2026
Status: 2025 Medicare Fee Schedule Compliant

CPT 99231 - Subsequent Hospital Care (Level 1)

Description & Explanation: Used for daily hospital rounds (follow-up) for a patient who is improving or stable. This is the lowest level of subsequent care.

• Requires a medically appropriate history/exam.

• MDM: Straightforward or Low.

• Time: 25 minutes (total time on date of encounter).

• Status: Patient is typically stable, recovering, or has a resolving problem.

Code Tree:

• Evaluation and Management

  • Hospital Inpatient or Observation Care

    • Subsequent Care

      • 99231: Subsequent hospital care, low MDM or 25 min

Technical Data:

• WRVU (2025): ~0.80

• Global Period: XXX

• Assistant Payable: No

• HCC Information: N/A

Bundling & Edits:

• Exclusive: Cannot be billed on the same day as Initial Care (9922x) or Discharge (99238/9) by the same provider.

Clinical Examples:

1. Stable Recovery: Day 3 of admission for cellulitis. Erythema receding, patient afebrile. IV antibiotics continued.

2. Awaiting Placement: Patient medically cleared for discharge but waiting for SNF bed. Vitals stable, no new complaints.