go back

New York rates for HCPCS 99231

Subsequent hospital inpatient or observation care, per day, for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and straightforward or low level of medical decision making. When using total time on the date of the encounter for code selection, 25 minutes must be met or exceeded.

Facilitymedian $58 · 10th–90th $30–$2000%10%10th90th$58Professionalmedian $59 · 10th–90th $30–$1150%10%10th90th$59$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $57.54 / $181.97
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$147.91 / $436.52 / $436.52
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $57.54 / $109.65
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$40.74 / $81.28 / $190.55
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $45.71 / $81.28
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$41.69 / $41.69 / $83.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $33.11 / $91.20
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $141.25 / $53,703.18
Cigna
Facility/Professional
Facility
Modifier
22
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Cigna
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$7.59 / $7.59 / $7.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $57.54 / $134.90
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $52.48 / $123.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $50.12 / $81.28
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $53.70 / $97.72
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $48.98 / $120.23
Highmark BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$41.69 / $102.33 / $123.03
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $54.95 / $100.00
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $44.67 / $79.43
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $54.95 / $154.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $61.66 / $97.72
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.50 / $40.74 / $117.49
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$14.79 / $52.48 / $125.89