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Texas 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 $229 · 10th–90th $158–$7590%10%20%10th90th$229Professionalmedian $186 · 10th–90th $132–$4370%10%10th90th$186$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
$154.88 / $162.18 / $218.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $190.55 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $165.96 / $251.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $562.34 / $1,023.29
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $154.88 / $204.17
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $218.78 / $489.78
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $190.55 / $190.55
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $239.88 / $407.38
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,202.26 / $1,202.26
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$194.98 / $1,202.26 / $1,202.26
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $218.78 / $371.54
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $194.98 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $120.23
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $288.40 / $562.34
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $234.42 / $389.05
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $234.42 / $416.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $199.53 / $234.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $218.78 / $338.84
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $162.18 / $190.55