go back

Missouri 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 $204 · 10th–90th $129–$3240%20%10th90th$204Professionalmedian $240 · 10th–90th $141–$5890%10%10th90th$240$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
$128.82 / $204.17 / $323.59
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $223.87 / $575.44
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $316.23 / $676.08
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $204.17 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$165.96 / $218.78 / $275.42
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $190.55 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $223.87 / $295.12
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $147.91 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $218.78 / $363.08
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $208.93 / $363.08
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $263.03 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$204.17 / $269.15 / $380.19
Qualchoice
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $251.19 / $331.13
Qualchoice
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$245.47 / $251.19 / $302.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $169.82 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $323.59
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $85.11 / $295.12