Cost analysis for CPT 99231 — Subsequent hospital care with straightforward or low level of medical decision making, per day, if using time, at least 25 minutes
Average Medicare Payment
N/A
Total Payments (Latest)
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Services (Latest)
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Price Change (–)
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The most expensive state pays 1.5x more than the cheapest for this procedure. AK averages $50.47 vs ID at $34.18.
| State | Avg Payment | Total Payments | Services | Providers |
|---|---|---|---|---|
| AK | $50.47 | $480.7K | 9.5K | 135 |
| NY | $42.04 | $12.3M | 293.4K | 3.7K |
| DC | $41.89 | $420.2K | 10.0K | 124 |
| CA | $40.45 | $9.3M | 228.8K | 2.6K |
| NJ | $40.27 | $6.1M | 150.7K | 1.6K |
| MD | $39.43 | $2.9M | 72.6K | 944 |
| IL | $39.12 | $5.9M | 150.4K | 2.1K |
| CT | $38.90 | $2.5M | 63.2K | 1.0K |
| FL | $38.62 | $11.5M | 296.7K | 3.3K |
| MA | $38.42 | $6.4M | 165.4K | 1.8K |
| MI | $38.35 | $5.3M | 137.6K | 2.0K |
| HI | $38.24 | $199.1K | 5.2K | 88 |
| NV | $38.10 | $1.5M | 39.6K | 342 |
| PA | $37.70 | $9.4M | 248.2K | 3.0K |
| GU | $37.46 | $18.8K | 503 | 6 |
| MT | $37.45 | $525.2K | 14.0K | 241 |
| VA | $37.43 | $3.6M | 97.4K | 1.5K |
| RI | $37.42 | $514.7K | 13.8K | 206 |
| DE | $37.40 | $968.3K | 25.9K | 338 |
| PR | $37.31 | $56.8K | 1.5K | 17 |
| VI | $37.25 | $27.6K | 741 | 3 |
| TX | $37.19 | $9.4M | 253.6K | 2.7K |
| WA | $37.13 | $2.2M | 60.2K | 997 |
| NH | $36.97 | $955.1K | 25.8K | 432 |
| CO | $36.95 | $994.8K | 26.9K | 503 |
| LA | $36.93 | $2.9M | 78.9K | 672 |
| AZ | $36.87 | $1.5M | 39.7K | 747 |
| GA | $36.78 | $3.1M | 83.0K | 1.3K |
| WV | $36.70 | $1.2M | 33.1K | 457 |
| NM | $36.62 | $378.3K | 10.3K | 174 |
| OR | $36.48 | $1.2M | 32.0K | 619 |
| MO | $36.45 | $3.4M | 93.5K | 1.4K |
| ND | $36.40 | $636.1K | 17.5K | 255 |
| ME | $36.36 | $539.9K | 14.8K | 308 |
| SC | $36.34 | $2.6M | 72.1K | 849 |
| OH | $36.15 | $4.6M | 126.9K | 2.3K |
| KY | $36.14 | $2.8M | 77.5K | 907 |
| VT | $36.13 | $308.2K | 8.5K | 156 |
| OK | $36.01 | $1.4M | 40.1K | 514 |
| UT | $36.00 | $385.7K | 10.7K | 220 |
| NC | $35.78 | $3.2M | 89.4K | 1.5K |
| AL | $35.73 | $2.6M | 73.5K | 637 |
| WY | $35.60 | $272.1K | 7.6K | 95 |
| MN | $35.53 | $1.8M | 50.0K | 1.1K |
| KS | $35.44 | $1.4M | 40.9K | 594 |
| AR | $35.26 | $2.7M | 75.6K | 634 |
| IN | $35.23 | $3.1M | 87.3K | 1.3K |
| WI | $35.20 | $2.0M | 55.7K | 1.1K |
| SD | $35.13 | $546.1K | 15.5K | 254 |
| TN | $34.93 | $3.4M | 98.5K | 1.1K |
| IA | $34.90 | $1.6M | 46.0K | 735 |
| Provider | Specialty | State | Payments | Services | Avg/Service |
|---|---|---|---|---|---|
| Davinder Singh | Internal Medicine | CA | $373.4K | 9.0K | $41.34 |
| Gadson Johnson | Psychiatry | CA | $333.3K | 8.1K | $41.09 |
| Bonnie Dungan | Physical Medicine and Rehabilitation | AL | $313.2K | 8.6K | $36.34 |
| Konstantinos Kallinikos | Podiatry | NY | $276.4K | 6.1K | $45.42 |
| Kevin Collins | Physical Medicine and Rehabilitation | AR | $211.7K | 5.9K | $36.00 |
| Travis Hird | Physical Medicine and Rehabilitation | TX | $210.4K | 5.6K | $37.38 |
| Devin Troyer | Physical Medicine and Rehabilitation | SC | $198.1K | 5.4K | $36.71 |
| Dwarakanath Vuppalapati | Psychiatry | NV | $194.2K | 4.9K | $39.31 |
| Dharam Gurwara | Neurology | LA | $193.7K | 5.1K | $38.22 |
| Samir Farhat | Internal Medicine | NY | $189.4K | 4.1K | $45.90 |
| W Lorenz | Physical Medicine and Rehabilitation | SC | $188.1K | 5.1K | $37.08 |
| Bradley Short | Physical Medicine and Rehabilitation | AR | $182.7K | 5.1K | $35.50 |
| Shoaib Qureshi | Family Practice | TN | $180.9K | 4.8K | $37.49 |
| Hiruy Gessesse | Psychiatry | CA | $179.4K | 4.3K | $41.94 |
| Mario Pacheco | Nurse Practitioner | CA | $175.5K | 5.0K | $35.04 |
| Darin Wilbourn | Physical Medicine and Rehabilitation | AR | $163.0K | 4.5K | $36.11 |
| Benny Green | Family Practice | AR | $151.0K | 4.2K | $36.30 |
| John Disaia | Plastic and Reconstructive Surgery | CA | $147.3K | 3.6K | $41.34 |
| Albert Sydney | Psychiatry | PA | $145.8K | 3.6K | $40.80 |
| William Rowe | Physical Medicine and Rehabilitation | TX | $143.0K | 3.8K | $37.69 |
Based on the data, CPT 99231 shows a 1.5x variation in pricing across states — moderate variation by Medicare standards.
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.