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Massachusetts 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 $209 · 10th–90th $112–$4170%10%20%10th90th$209Professionalmedian $257 · 10th–90th $148–$6610%5%10%10th90th$257$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$162.18 / $229.09 / $302.00
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$416.87 / $416.87 / $416.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $229.09 / $616.60
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$173.78 / $338.84 / $741.31
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $602.56 / $1,122.02
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $660.69
AllWays Health Partners
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$91.20 / $144.54 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $269.15 / $478.63
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $354.81 / $478.63
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$151.36 / $194.98 / $263.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $245.47 / $467.74
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $138.04 / $257.04
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $204.17 / $389.05
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $331.13 / $588.84
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $263.03 / $660.69
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $346.74 / $1,318.26
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $602.56 / $1,122.02
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $660.69
Mass General Brigham
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$91.20 / $144.54 / $275.42
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $190.55 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $169.82 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $263.03 / $575.44
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$85.11 / $213.80 / $457.09