NPI Portal NPI Lookup & Verification

Hospital inpatient & observation

99238 - RVUs & Medicare payment (2026)

Hospital discharge management, 30 minutes or less.

Component Non-facility Facility
Work RVU 1.50 1.50
Practice expense RVU 0.62 0.62
Malpractice RVU 0.12 0.12
Total RVUs 2.24 2.24
National payment (CF $33.4009) $74.82 $74.82
Qualifying APM payment (CF $33.5675) $75.19 $75.19

How 99238 payment varies by locality

Medicare adjusts payment with geographic practice cost indices, so the same code pays differently across the 109 fee schedule localities. In 2026, non-facility payment for 99238 ranges from $69.95 in Arkansas (AR) to $99.42 in Alaska (AK); calculate 99238 for your locality.

Alaska (AK) $99.42 San Jose-Sunnyvale-Santa Clara (CA) $87.62 San Jose-Sunnyvale-Santa Clara (CA) $87.07 San Francisco-Oakland-Berkeley (CA) $85.90 San Francisco-Oakland-Berkeley (CA) $85.76 NYC Suburbs/Long Island (NY) $85.37 Manhattan (NY) $83.73 Queens (NY) $83.57 National average $74.82 … 97 more localities between … Nebraska (NE) $70.73 Iowa (IA) $70.64 Alabama (AL) $70.49 Arkansas (AR) $69.95
Non-facility payment for 99238 in the 2026 fee schedule ($33.4009 conversion factor), before sequestration. Gray bar = national average.

Global period: XXX

No global period: the global surgery concept does not apply to this code.

Related codes - hospital inpatient & observation

  • 99221 · initial hospital or observation visit, level 1
  • 99222 · initial hospital or observation visit, level 2
  • 99223 · initial hospital or observation visit, level 3
  • 99231 · subsequent hospital or observation visit, level 1
  • 99232 · subsequent hospital or observation visit, level 2
  • 99233 · subsequent hospital or observation visit, level 3
  • 99239 · hospital discharge management, more than 30 minutes

Frequently asked questions

How much does Medicare pay for 99238 in 2026?
The national non-facility payment is $74.82 and the facility payment is $74.82, using the standard $33.4009 conversion factor. Actual amounts vary by Medicare locality; use the RVU calculator for your area.
What is the work RVU for 99238?
The 2026 work RVU for 99238 is 1.50. Total RVUs are 2.24 in the non-facility setting and 2.24 in the facility setting.
Why are the facility and non-facility amounts different?
Only the practice expense component changes by setting. In an office (non-facility) the practice bears the overhead, so the PE RVU is higher; in a hospital or ASC the facility bills its own overhead separately.

Source: CMS Physician Fee Schedule relative value file (rvu26c.zip, retrieved 2026-07-11). Service description is an original plain-English summary, not CPT descriptor text. CPT® is a registered trademark of the American Medical Association. Amounts are estimates before sequestration and claim-level adjustments.