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Nationwide rates for HCPCS 99218

Initial observation care, per day, for the evaluation and management of a patient which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the problem(s) requiring admission to outpatient hospital "observation status" are of low severity. Typically, 30 minutes are spent at the bedside and on the patient's hospital floor or unit.

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	Facility/Professional	Typical Low	Median	Typical High
BCBS Facility/Professional Facility Modifier Typical Low / Median / Typical High $131.83 / $218.78 / $977.24	Facility	$131.83	$218.78	$977.24
Cigna Facility/Professional Facility Modifier Typical Low / Median / Typical High $245.47 / $338.84 / $812.83	Facility	$245.47	$338.84	$812.83
Cigna Facility/Professional Professional Modifier Typical Low / Median / Typical High $169.82 / $229.09 / $389.05	Professional	$169.82	$229.09	$389.05
United Facility/Professional Facility Modifier Typical Low / Median / Typical High $15.14 / $91.20 / $100.00	Facility	$15.14	$91.20	$100.00
United Facility/Professional Professional Modifier Typical Low / Median / Typical High $66.07 / $97.72 / $162.18	Professional	$66.07	$97.72	$162.18

Nationwide rates for HCPCS 99218

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