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Pennsylvania 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 $49 · 10th–90th $49–$590%50%90th$49Professionalmedian $79 · 10th–90th $49–$1380%20%10th90th$79$50.0$100.0

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
Geisinger
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $58.88
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $48.98 / $83.18
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $125.89 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $85.11 / $114.82