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Massachusetts 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 $145 · 10th–90th $89–$1,5140%10%20%10th90th$145Professionalmedian $112 · 10th–90th $68–$2140%10%20%10th90th$112$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
$97.72 / $138.04 / $1,513.56
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$72.44 / $588.84 / $3,162.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $109.65 / $218.78
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $199.53 / $1,202.26
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $131.83 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $218.78 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $154.88 / $204.17
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $144.54 / $213.80
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $87.10 / $239.88
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $83.18 / $125.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $194.98
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $758.58 / $1,288.25
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $144.54 / $616.60
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $199.53 / $1,202.26
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $131.83 / $616.60
Tufts
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $524.81 / $1,288.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $134.90 / $223.87