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Texas 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 $224 · 10th–90th $148–$4470%10%20%10th90th$224Professionalmedian $209 · 10th–90th $145–$4900%20%10th90th$209$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$141.25 / $204.17 / $489.78
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$128.82 / $354.81 / $512.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $208.93 / $489.78
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$165.96 / $288.40 / $676.08
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $208.93 / $288.40
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$169.82 / $223.87 / $275.42
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $416.87 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $177.83 / $218.78
Baylor Scott & White
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$602.56 / $602.56 / $602.56
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $229.09 / $398.11
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $186.21 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $173.78 / $251.19
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $371.54
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $1,122.02 / $1,122.02
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $257.04 / $1,380.38
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $223.87 / $380.19
Moda Health
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$74.13 / $354.81 / $446.68
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $190.55 / $363.08
Moda Health
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$162.18 / $281.84 / $660.69
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $60.26 / $117.49
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $363.08 / $851.14
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $223.87 / $380.19
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $223.87 / $426.58
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $177.83 / $275.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $194.98 / $309.03
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$70.79 / $181.97 / $295.12
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $229.09 / $257.04