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Massachusetts rates for HCPCS 99223

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 high level of medical decision making. When using total time on the date of the encounter for code selection, 75 minutes must be met or exceeded.

Facilitymedian $245 · 10th–90th $195–$5890%20%10th90th$245Professionalmedian $195 · 10th–90th $129–$4070%20%10th90th$195$50.0$200.0$1.0K$5.0K$20.0K

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
$194.98 / $245.47 / $338.84
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$151.36 / $954.99 / $3,019.95
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $186.21 / $407.38
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $426.58 / $2,951.21
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $1,202.26
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$199.53 / $457.09 / $616.60
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $316.23 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $288.40 / $426.58
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $181.97 / $501.19
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $173.78 / $269.15
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $281.84 / $407.38
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $173.78 / $5,011.87
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $309.03 / $524.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $426.58 / $2,951.21
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $263.03 / $1,202.26
Tufts
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $186.21 / $346.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $467.74