According to the CMS, if reimbursement is to be received, the time a patient can be considered in observation status is 24 hours, and all costs beyond 24 hours will be included in the composite ambulatory payment group (APG) payments. Patients may be in an observation category for up to 48 hours (ACEP, 2015; Brillman et al., 1994; Centers for Medicare and Medicaid Services [CMS], 2015).