How to Bill CPT 99226 for Hospital and Inpatient E/M Services

When to Use CPT Code 99226

CPT 99226 is used for hospital-based evaluation and management (E/M) services, including inpatient, observation, and facility care.

• •Service type: Hospital / inpatient E/M
• •Setting: Hospital, observation unit, or facility
• •Billing basis: Medical decision making or total time

Common scenarios:

• •Initial hospital admission
• •Daily inpatient rounds
• •Observation care
• •Hospital discharge management
• •Facility-based patient care

Insurance Verification Tips for CPT 99226

1. •Confirm patient status (observation vs inpatient).
2. •Select codes based on documented complexity or time.
3. •Track admission and discharge dates carefully.
4. •Avoid duplicate billing across care settings.

Example Case of CPT 99226

A provider evaluates and manages a hospitalized or facility-based patient and documents the appropriate level of care.
The service is billed as one unit of CPT 99226.