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Wisconsin 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–$4900%10%20%10th90th$204Professionalmedian $269 · 10th–90th $145–$6460%10%10th90th$269$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
$123.03 / $204.17 / $407.38
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$162.18 / $457.09 / $575.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $229.09 / $630.96
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$181.97 / $371.54 / $741.31
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $288.40 / $512.86
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $316.23
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $263.03 / $489.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $676.08 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $371.54 / $630.96
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $194.98 / $380.19
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $407.38 / $562.34
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $204.17 / $416.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $389.05 / $1,380.38
Medica
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$426.58 / $588.84 / $645.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $223.87
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $309.03 / $478.63
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $407.38 / $588.84
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$338.84 / $338.84 / $1,122.02
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $338.84 / $1,380.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $213.80 / $257.04
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $346.74 / $457.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $158.49 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $478.63 / $724.44
United
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$79.43 / $91.20 / $426.58