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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 October 2026.

How much rates vary

Facilitymedian $295 · 10th to 90th $257 to $437Professionalmedian $347 · 10th to 90th $200 to $479
$200$500facility $295professional $347

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

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Facility
Modifier
None
Typical Low
$257.04
Median
$295.12
Typical High
$436.52
Cigna
Setting
Professional
Modifier
None
Typical Low
$165.96
Median
$281.84
Typical High
$323.59
Medica
Setting
Professional
Modifier
None
Typical Low
$478.63
Median
$478.63
Typical High
$478.63