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Maine 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 $525 · 10th–90th $166–$5,6230%20%10th90th$525Professionalmedian $186 · 10th–90th $129–$3470%20%10th90th$186$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$165.96 / $524.81 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $177.83 / $346.74
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $251.19 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $263.03 / $489.78
Community Health Options
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $275.42 / $275.42
Community Health Options
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $257.04 / $346.74
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $234.42 / $407.38
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $316.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $263.03 / $389.05