Can I submit a subsequent hospital visit if my documentation does not support one of the three levels of an initial hospital visit?

Yes, subsequent hospital CPT codes (99232 and 99231) can be submitted in place of initial hospital CPT codes (99221-99223) if the minimum key component work and/or medical necessity requirements for initial care services are not met.


  • CMS IOM 100-04, Medicare Claims Processing Manual, Chapter 12 (PDF, 1.05 MB), Section F
  • CMS MLN Matters Article MM7405 (PDF, 100 KB)

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