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Observation Follow-Up Visit, High Complexity

Wisconsin 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 July 2026.

Facilitymedian $302 · 10th–90th $234$4790%20%10th90th$302Professionalmedian $282 · 10th–90th $79$4790%10%20%10th90th$282$100.0$200.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Cigna
Setting
Facility
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$281.84
Typical High
$323.59
Medica
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$58.88
Typical High
$70.79
Quartz
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$234.42
Typical High
$234.42
Quartz
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$478.63
Typical High
$478.63
United
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$87.10
Typical High
$169.82