Prior Auth Required

99235 - Hospital inpatient or observation care, for the evaluation and management of a patient including admission

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceHospital inpatient or observation care, for the evaluation and management of a patient including admission
Procedure / Service Description

Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, - straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded. 99235 Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.