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Observation Follow-Up Visit, High Complexity

New York rates for HCPCS 99226

A follow-up visit by the doctor to a patient under observation in hospital whose condition is unstable or has worsened. It covers a detailed reassessment, a full review of new findings, and complex decisions about changing treatment or moving to a full admission.

Rates data updated October 2026.

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

$145

Typical physician fee. In New York, October 2026.

Insurers have agreed to pay about $145 for this service. Most negotiated rates run $145 to $145.

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.

How much rates vary

Professionalmedian $145 · 10th to 90th $145 to $145
$100$200professional $145

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
CDPHP
Setting
Professional
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
MVP Health Care
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
United
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$263.03
1 more rate with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Emblem Health
Setting
Professional
Modifier
GL · Free upgrade
Typical Low
$112.20
Median
$112.20
Typical High
$112.20

Where New York sits

The same service costs 15.8 times more in Massachusetts than in Idaho. 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· 24th of 37

$145

MA $479ID $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.