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Observation Follow-Up Visit, Moderate Complexity

New York rates for HCPCS 99225

A follow-up visit by the doctor to a patient already being kept under observation in hospital. The doctor reviews how you have responded, checks results that have come back and adjusts the plan. This version covers a moderately involved review, where the picture is changing or several findings have to be weighed together.

Rates data updated July 2026.

How much does Observation Follow-Up Visit, Moderate Complexity cost?

$97.72

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $97.72 for this service. The price depends on where it is billed: about $100 from a physician practice, and about $42.66 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$100$85.11 to $100
FacilityA hospital or hospital-owned outpatient department$42.66$0.10 to $100

How much rates vary

Facilitymedian $43 · 10th to 90th $0 to $550Professionalmedian $100 · 10th to 90th $79 to $110
$0.1$1$10$100$1Kfacility $43professional $100

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$0.10
Median
$0.10
Typical High
$0.10
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
United
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$512.86
Typical High
$2,570.40
United
Setting
Professional
Modifier
Global
Typical Low
$69.18
Median
$87.10
Typical High
$107.15

Where New York sits

The same service costs 11.2 times more in Tennessee than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

New York· 25th of 49

$97.72

TN $339SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.