Duplicate Initial Observation Service

Date Issued: 7/16/2018

The following is in accordance with CPT coding guidelines from the American Medical Association (AMA) and the Centers for Medicare & Medicaid Services (CMS).

These observation care codes are strictly for the first day of treatment:

  • Initial observation care (CPT codes 99218-99220).
  • Treatment that includes initial observation care (CPT codes 99234-99236).

Treatment that is given on subsequent days should be billed with another code, such as:

  • An observation care discharge (CPT code 99217).
  • Initial hospital visit (CPT codes 99221-99223).

Only one initial observation care code will be allowed throughout a hospital stay. Claims will be denied if codes for the first day of treatment are used for care given on subsequent days.

Our Call Center is currently experiencing extremely high volume and longer wait times. For questions related to COVID-19, visit our COVID-19 FAQs