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Wisconsin rates for HCPCS 99219

Initial observation care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate 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 moderate severity. Typically, 50 minutes are spent at the bedside and on the patient's hospital floor or unit.

Facilitymedian $447 · 10th–90th $331–$6170%20%10th90th$447Professionalmedian $372 · 10th–90th $85–$6310%10%20%10th90th$372$100.0$200.0$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$331.13 / $389.05 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$208.93 / $371.54 / $416.87
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$630.96 / $630.96 / $630.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $70.79
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $467.74 / $467.74
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $630.96 / $630.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $109.65 / $245.47