Inpatient Hospital E/M wRVU Values for Hospitalists and Consultants (2026)

Why inpatient E/M codes stand apart

The outpatient office visit codes most compensation guides focus on — the 99202–99215 family — are only one corner of physician evaluation and management work. Hospitalists, house staff, and specialists doing inpatient rounds credit their production through a parallel family of hospital-based codes. These codes have different wRVU values than their outpatient counterparts, and understanding them matters for anyone whose paycheck runs partly or entirely on inpatient production.

Inpatient E/M coding separates into three groups based on where you are in the admission: initial care (the first documented encounter for the admission), subsequent care (each follow-up visit during the stay), and discharge (the day the patient leaves). Observation and same-day admit-and-discharge encounters use their own codes. Each group has different wRVU values, and the selection criteria changed in 2023 when CMS updated inpatient E/M documentation requirements to allow selection based on either medical decision-making (MDM) complexity or total physician time — aligning the inpatient rules with the outpatient overhaul that took effect in 2021.

All wRVU values in this guide come from the 2026 CMS Physician Fee Schedule and are the same values used for physician compensation under wRVU-based contracts. They are identical regardless of specialty, employer, or geography; only the dollar rate your employer applies to them differs.

Hospital initial care: 99221, 99222, 99223

Initial hospital care codes apply the first time you document the management of a new hospital admission. Each code maps to a level of medical complexity:

Two comparisons help put these in context. A 99222 (moderate complexity, 2.60 wRVUs) earns exactly the same credit as a 99204 — the moderate-complexity new outpatient visit — because CMS benchmarks the physician work for a new hospital admission at the same level as a new outpatient encounter of matching complexity. A 99223 (high complexity, 3.50 wRVUs) matches a 99205, the highest-level new outpatient visit.

For a hospitalist admitting a patient with a new acute condition requiring extensive workup and decision-making, 99223 is typically appropriate. Straightforward elective admissions or lower-acuity presentations more often support 99221. The majority of medical admissions, those with moderate complexity, fall at 99222.

Subsequent hospital care: 99231, 99232, 99233

Once a patient is admitted, every face-to-face visit during that hospitalization uses the subsequent care codes. These are the codes that make up the bulk of a hospitalist's daily volume:

Subsequent care codes earn fewer wRVUs per encounter than initial visits because the admission workup is behind you and the visit reflects ongoing management rather than a new assessment. The 99232 is the most commonly billed level for a monitored patient who is responding as expected but still requires active management.

The 99233 applies to encounters involving high medical complexity — a patient whose condition is worsening, whose response to treatment is inadequate, or whose care requires interpreting significant new data and adjusting a complex management plan. At 2.40 wRVUs, it earns more than a level-4 established outpatient visit (99214, 1.92 wRVUs) and approaches a level-5 established visit (99215, 2.80 wRVUs). Appropriate use requires documentation that genuinely supports high-complexity MDM.

As a rough illustration: a hospitalist rounding on 15 patients, most of whom are stable but still admitted, with 13 subsequent visits at 99232 and 2 at 99233 would generate approximately 20.67 + 4.80 = roughly 25.5 wRVUs from those visits alone, before admissions, discharges, or any procedures.

Hospital discharge: 99238 and 99239

Discharge codes are frequently underused. When you personally perform and document the discharge-day management — reviewing pending results, coordinating follow-up, reconciling medications, writing the discharge summary — you are entitled to bill for that work separately from any rounding on the same date. The two codes split on physician time:

One important rule: on the day of discharge you bill the discharge code for that patient, not a subsequent care code. The discharge code covers all services you provide to that patient on the day they leave, so a separate 99231–99233 on the same date for the same patient is not appropriate.

For a hospitalist discharging two or three patients on a rounding day, adding the discharge codes to the daily count meaningfully affects total wRVU production. At 1.50–2.15 wRVUs per discharge, three discharges contribute 4.50–6.45 wRVUs to the day.

Observation same-day admit and discharge: 99234, 99235, 99236

When a patient is admitted to and discharged from observation on the same calendar date, a combined code covers both the admission workup and the discharge management. These codes are selected by MDM complexity, same as initial care:

These carry the highest wRVU values in the inpatient E/M family. A 99236, at 4.30 wRVUs, exceeds every other inpatient E/M code — including the highest-level initial care code (99223 at 3.50) and the highest-level new outpatient visit (99205 at 3.50). The higher value reflects the bundled nature of the code: it captures both the initial workup and the discharge-day management, which are normally two separate encounters in a traditional hospitalization.

Inpatient consult codes: 99252–99255

You may see codes 99252–99255 on employer-issued wRVU production reports or in internal crediting schedules. Here is what they are and what their current status means in practice:

Medicare does not pay these codes. CMS removed inpatient consultation codes from the Medicare Physician Fee Schedule effective January 1, 2010. When you are called to see a Medicare inpatient at another physician's request, you bill the appropriate initial hospital care code (99221, 99222, or 99223) based on the complexity of your work, not 99252–99255. The initial care code is used regardless of whether you will be following the patient or returning primary care to the requesting physician.

Several commercial payers and some state Medicaid programs still recognize and pay the consult codes. The specific payer policies vary, so check your contracts with individual payers to know which codes they accept.

Many hospital employers continue to credit consult codes internally for wRVU production tracking purposes, applying the CPT wRVU values listed above even when the external claim uses a different code. If your employment contract includes language about wRVU crediting for consults, verify exactly which codes your employer recognizes and whether that crediting applies to Medicare encounters as well as commercially insured ones.

The wRVU values in the table come from the CPT codebook and CMS Physician Fee Schedule data; their presence in the fee schedule data does not indicate that Medicare reimburses the codes.

What a typical inpatient production day looks like

Putting the code values together, a hospitalist rounding on a moderate-volume service might see something like: two new admissions averaging 99222 (2.60 wRVUs each), twelve subsequent visits at 99232 (1.59 wRVUs each), and two discharges at 99238 (1.50 wRVUs each). That adds up to 5.20 + 19.08 + 3.00 = approximately 27 wRVUs for the day before any critical care encounters, procedures, or higher-complexity admissions.

Annualized over roughly 190–220 clinical days for a full-time hospitalist — a range that reflects typical shift scheduling patterns after accounting for days off, non-clinical obligations, and rotation structure — a production rate of 24–30 wRVUs per clinical day translates to approximately 4,500–6,600 wRVUs per year. Compensation surveys from various sources typically report full-time hospitalist wRVU production in a range of approximately 4,200 to 5,200 annually, though figures differ materially by survey, year, and practice setting, and direct comparison requires using the same survey source and specialty definition.

Specialist consultants doing inpatient work generate wRVUs through the same initial care and consult code families, but volume depends on how many consults they receive and how many patients they follow longitudinally. For most consulting specialists, the per-day wRVU count from inpatient activity is typically lower than a hospitalist's because consult volume is sparser, but high-complexity codes are more common.