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Kentucky rates for HCPCS 99205

Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and high level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $158 · 10th–90th $117–$2290%20%40%10th90th$158Professionalmedian $224 · 10th–90th $141–$5750%10%20%10th90th$224$1.0$5.0$20.0$100.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $154.88 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $213.80 / $524.81
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$165.96 / $309.03 / $676.08
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $281.84
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $223.87 / $281.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $154.88 / $234.42
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$165.96 / $194.98 / $275.42
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $239.88 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $281.84 / $281.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $223.87 / $1,047.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $112.20 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $208.93 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $186.21 / $295.12
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $91.20 / $295.12