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
Average Medicare Payment
$62.47
2023 data
Total Payments (2023)
$38.3M
Services (2023)
609.4K
Price Change (2014–2023)
-19.5%
| Year | Avg Payment | Total Payments | Services | YoY Change |
|---|---|---|---|---|
| 2014 | $77.61 | $110.5M | 1.4M | — |
| 2015 | $77.85 | $109.3M | 1.4M | +0.3% |
| 2016 | $77.12 | $110.7M | 1.4M | -0.9% |
| 2017 | $77.41 | $109.9M | 1.4M | +0.4% |
| 2018 | $77.58 | $106.3M | 1.4M | +0.2% |
| 2019 | $78.38 | $104.0M | 1.3M | +1.0% |
| 2020 | $79.95 | $83.3M | 1.0M | +2.0% |
| 2021 | $78.46 | $76.5M | 972.3K | -1.9% |
| 2022 | $76.86 | $69.5M | 899.6K | -2.0% |
| 2023 | $62.47 | $38.3M | 609.4K | -18.7% |
The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $83.50 vs AR at $55.81.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $83.50 | $28.8K | 345 | 20 |
| NY | $71.52 | $4.3M | 59.7K | 1.7K |
| DC | $68.90 | $79.5K | 1.2K | 32 |
| CA | $66.89 | $1.9M | 28.0K | 992 |
| NJ | $66.24 | $1.7M | 26.1K | 754 |
| MA | $64.67 | $1.2M | 18.2K | 626 |
| CT | $64.50 | $711.6K | 11.0K | 396 |
| MD | $64.45 | $827.0K | 12.8K | 393 |
| IL | $64.38 | $2.1M | 32.6K | 1.0K |
| FL | $64.22 | $3.7M | 56.9K | 1.7K |
| MI | $63.78 | $1.1M | 18.0K | 592 |
| RI | $63.68 | $99.8K | 1.6K | 65 |
| PA | $62.63 | $2.6M | 40.9K | 1.5K |
| DE | $62.11 | $358.8K | 5.8K | 158 |
| HI | $61.85 | $49.0K | 792 | 28 |
| TX | $61.54 | $2.2M | 36.0K | 1.1K |
| VT | $61.52 | $53.1K | 863 | 42 |
| VA | $61.36 | $983.8K | 16.0K | 561 |
| PR | $61.29 | $18.9K | 308 | 14 |
| WA | $61.16 | $269.9K | 4.4K | 174 |
| LA | $60.97 | $453.6K | 7.4K | 220 |
| MO | $60.86 | $944.9K | 15.5K | 504 |
| OR | $60.83 | $186.4K | 3.1K | 121 |
| WV | $60.78 | $390.3K | 6.4K | 227 |
| NV | $60.67 | $328.2K | 5.4K | 148 |
| AZ | $60.54 | $478.7K | 7.9K | 316 |
| GA | $60.54 | $910.3K | 15.0K | 559 |
| NH | $60.31 | $121.3K | 2.0K | 79 |
| OH | $60.16 | $2.2M | 36.4K | 1.2K |
| CO | $60.06 | $166.1K | 2.8K | 140 |
| NM | $59.97 | $53.8K | 897 | 45 |
| OK | $59.75 | $281.4K | 4.7K | 161 |
| NC | $59.72 | $706.6K | 11.8K | 486 |
| AL | $59.53 | $392.6K | 6.6K | 224 |
| MN | $59.33 | $412.9K | 7.0K | 330 |
| KY | $59.20 | $860.8K | 14.5K | 467 |
| ME | $58.97 | $138.4K | 2.3K | 88 |
| SC | $58.92 | $645.6K | 11.0K | 370 |
| MT | $58.74 | $73.3K | 1.2K | 51 |
| ND | $58.49 | $135.4K | 2.3K | 85 |
| KS | $58.13 | $343.8K | 5.9K | 202 |
| IN | $58.07 | $814.9K | 14.0K | 502 |
| MS | $57.90 | $424.0K | 7.3K | 203 |
| SD | $57.62 | $80.4K | 1.4K | 70 |
| WY | $57.46 | $45.8K | 797 | 28 |
| UT | $57.26 | $132.5K | 2.3K | 84 |
| TN | $57.14 | $763.2K | 13.4K | 444 |
| WI | $57.05 | $630.0K | 11.0K | 444 |
| IA | $56.80 | $293.9K | 5.2K | 209 |
| NE | $56.62 | $202.7K | 3.6K | 115 |
| ID | $56.36 | $54.3K | 963 | 44 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Stephen Veluz | Internal Medicine | MO | $77.1K | 1.2K | $64.41 |
| Kung-Ming Jan | Internal Medicine | NY | $57.6K | 767 | $75.11 |
| Blakely Reeder | Nurse Practitioner | AR | $48.7K | 955 | $51.02 |
| Edbert Morales | Physical Medicine and Rehabilitation | NY | $46.5K | 594 | $78.23 |
| Robert Kaylakov | Physical Medicine and Rehabilitation | NY | $40.7K | 520 | $78.19 |
| Orlando Rodriguez | Internal Medicine | FL | $36.3K | 497 | $73.00 |
| Mindi Garner | Internal Medicine | KS | $36.1K | 577 | $62.56 |
| Rachel Fetner | Endocrinology | NY | $35.7K | 452 | $78.94 |
| Khalida Pathan | Internal Medicine | CA | $34.5K | 498 | $69.18 |
| Ashvinkumar Patel | Nephrology | TX | $29.7K | 518 | $57.31 |
| Abraham Cherukara | Internal Medicine | MA | $29.2K | 413 | $70.72 |
| Carol Anne Dillon | Physical Medicine and Rehabilitation | PA | $28.7K | 428 | $66.96 |
| Houssein Jahamy | Infectious Disease | OH | $28.2K | 456 | $61.75 |
| Michael Mellman | Endocrinology | FL | $28.0K | 404 | $69.39 |
| Woo Tak | Physical Medicine and Rehabilitation | NY | $27.4K | 356 | $77.10 |
| Visaharan Sivasubramaniam | Hospice and Palliative Care | NY | $26.9K | 348 | $77.16 |
| Carlos Guida | Hematology-Oncology | FL | $25.6K | 350 | $73.26 |
| Hana Ilan | Physical Medicine and Rehabilitation | NY | $25.3K | 324 | $78.23 |
| Kang Lee | Physical Medicine and Rehabilitation | TX | $24.7K | 391 | $63.23 |
| Sabah Varoqua | Infectious Disease | NJ | $24.7K | 351 | $70.36 |
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.
Note: All data is from publicly available Medicare records. OpenMedicare is an independent journalism project not affiliated with CMS.