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Kentucky rates for HCPCS 99221

Initial hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level medical decision making. When using total time on the date of the encounter for code selection, 40 minutes must be met or exceeded.

Facilitymedian $72 · 10th–90th $54–$1230%20%10th90th$72Professionalmedian $100 · 10th–90th $62–$1700%5%10%10th90th$100$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
$53.70 / $72.44 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $100.00 / $169.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $104.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $138.04
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $100.00 / $125.89
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $123.03
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $151.36 / $380.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $51.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $97.72 / $165.96