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Michigan rates for HCPCS 99225

Subsequent observation care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 25 minutes are spent at the bedside and on the patient's hospital floor or unit.

Facilitymedian $186 · 10th–90th $74$2040%20%10th90th$186Professionalmedian $81 · 10th–90th $69$980%10%20%10th90th$81$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $181.97 / $204.17
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $83.18 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $75.86 / $91.20