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Data Sources: Centers for Medicare & Medicaid Services (CMS), Medicare Provider Utilization and Payment Data
Disclaimer: This site is an independent journalism project. Data analysis and editorial content are not affiliated with or endorsed by CMS or any government agency. All spending figures are based on publicly available Medicare payment records.
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Methodology•Download Data
  1. Home
  2. Procedures
  3. 99221
  4. Cost Analysis

How Much Does Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes Cost on Medicare?

Cost analysis for CPT 99221 — Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes

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Average Medicare Payment

$62.47

2023 data

Total Payments (2023)

$38.3M

Services (2023)

609.4K

Price Change (2014–2023)

-19.5%

📈 Year-over-Year Cost Trend

YearAvg PaymentTotal PaymentsServicesYoY Change
2014$77.61$110.5M1.4M—
2015$77.85$109.3M1.4M+0.3%
2016$77.12$110.7M1.4M-0.9%
2017$77.41$109.9M1.4M+0.4%
2018$77.58$106.3M1.4M+0.2%
2019$78.38$104.0M1.3M+1.0%
2020$79.95$83.3M1.0M+2.0%
2021$78.46$76.5M972.3K-1.9%
2022$76.86$69.5M899.6K-2.0%
2023$62.47$38.3M609.4K-18.7%

🗺️ State-by-State Cost Variation

The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $83.50 vs AR at $55.81.

StateAvg PaymentTotal PaymentsServicesProviders
AK$83.50$28.8K34520
NY$71.52$4.3M59.7K1.7K
DC$68.90$79.5K1.2K32
CA$66.89$1.9M28.0K992
NJ$66.24$1.7M26.1K754
MA$64.67$1.2M18.2K626
CT$64.50$711.6K11.0K396
MD$64.45$827.0K12.8K393
IL$64.38$2.1M32.6K1.0K
FL$64.22$3.7M56.9K1.7K
MI$63.78$1.1M18.0K592
RI$63.68$99.8K1.6K65
PA$62.63$2.6M40.9K1.5K
DE$62.11$358.8K5.8K158
HI$61.85$49.0K79228
TX$61.54$2.2M36.0K1.1K
VT$61.52$53.1K86342
VA$61.36$983.8K16.0K561
PR$61.29$18.9K30814
WA$61.16$269.9K4.4K174
LA$60.97$453.6K7.4K220
MO$60.86$944.9K15.5K504
OR$60.83$186.4K3.1K121
WV$60.78$390.3K6.4K227
NV$60.67$328.2K5.4K148
AZ$60.54$478.7K7.9K316
GA$60.54$910.3K15.0K559
NH$60.31$121.3K2.0K79
OH$60.16$2.2M36.4K1.2K
CO$60.06$166.1K2.8K140
NM$59.97$53.8K89745
OK$59.75$281.4K4.7K161
NC$59.72$706.6K11.8K486
AL$59.53$392.6K6.6K224
MN$59.33$412.9K7.0K330
KY$59.20$860.8K14.5K467
ME$58.97$138.4K2.3K88
SC$58.92$645.6K11.0K370
MT$58.74$73.3K1.2K51
ND$58.49$135.4K2.3K85
KS$58.13$343.8K5.9K202
IN$58.07$814.9K14.0K502
MS$57.90$424.0K7.3K203
SD$57.62$80.4K1.4K70
WY$57.46$45.8K79728
UT$57.26$132.5K2.3K84
TN$57.14$763.2K13.4K444
WI$57.05$630.0K11.0K444
IA$56.80$293.9K5.2K209
NE$56.62$202.7K3.6K115
ID$56.36$54.3K96344

💰 Who Bills the Most for This Procedure?

ProviderSpecialtyStatePaymentsServicesAvg/Service
Stephen VeluzInternal MedicineMO$77.1K1.2K$64.41
Kung-Ming JanInternal MedicineNY$57.6K767$75.11
Blakely ReederNurse PractitionerAR$48.7K955$51.02
Edbert MoralesPhysical Medicine and RehabilitationNY$46.5K594$78.23
Robert KaylakovPhysical Medicine and RehabilitationNY$40.7K520$78.19
Orlando RodriguezInternal MedicineFL$36.3K497$73.00
Mindi GarnerInternal MedicineKS$36.1K577$62.56
Rachel FetnerEndocrinologyNY$35.7K452$78.94
Khalida PathanInternal MedicineCA$34.5K498$69.18
Ashvinkumar PatelNephrologyTX$29.7K518$57.31
Abraham CherukaraInternal MedicineMA$29.2K413$70.72
Carol Anne DillonPhysical Medicine and RehabilitationPA$28.7K428$66.96
Houssein JahamyInfectious DiseaseOH$28.2K456$61.75
Michael MellmanEndocrinologyFL$28.0K404$69.39
Woo TakPhysical Medicine and RehabilitationNY$27.4K356$77.10
Visaharan SivasubramaniamHospice and Palliative CareNY$26.9K348$77.16
Carlos GuidaHematology-OncologyFL$25.6K350$73.26
Hana IlanPhysical Medicine and RehabilitationNY$25.3K324$78.23
Kang LeePhysical Medicine and RehabilitationTX$24.7K391$63.23
Sabah VaroquaInfectious DiseaseNJ$24.7K351$70.36

🤔 Is Initial hospital care with straightforward or low level of medical decision making, per day, if using time, at least 40 minutes Overpriced?

Based on the data, CPT 99221 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.

Costs have decreased 19.5% since 2014. Medicare's fee schedule attempts to standardize pricing, though some variation is expected due to geographic cost-of-living adjustments and practice expense differences.

This analysis is based on publicly available CMS data and does not account for patient complexity, comorbidities, or facility-specific factors that may justify pricing differences.

Data Sources

  • • Centers for Medicare & Medicaid Services (CMS)
  • • Medicare Provider Utilization and Payment Data (2014-2023)
  • • Medicare Physician Fee Schedule

Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.