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Texas 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 $135 · 10th–90th $78–$5370%10%10th90th$135Professionalmedian $105 · 10th–90th $66–$2240%10%10th90th$105$20.0$100.0$500.0$2.0K

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
$77.62 / $83.18 / $602.56
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $107.15 / $229.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $100.00
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$123.03 / $281.84 / $512.86
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $74.13 / $95.50
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $109.65 / $194.98
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $83.18 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $120.23 / $204.17
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$616.60 / $616.60 / $616.60
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $616.60 / $616.60
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $123.03 / $204.17
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $114.82 / $194.98
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $60.26
Oscar Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,951.21 / $4,677.35
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $141.25 / $269.15
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $128.82 / $204.17
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $117.49 / $204.17
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $112.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $109.65 / $173.78
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $77.62 / $91.20