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Nationwide rates for HCPCS 99235

Hospital inpatient or observation care, for the evaluation and management of a patient including admission and discharge on the same date, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 70 minutes must be met or exceeded.

Facilitymedian $200 · 10th–90th $126$5500%20%40%10th90th$200Professionalmedian $234 · 10th–90th $145$4790%20%10th90th$234$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$120.23 / $162.18 / $295.12
Aetna
Facility/Professional
Facility
Modifier
25
Typical Low / Median / Typical High
$120.23 / $794.33 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $234.42 / $588.84
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $501.19 / $1,380.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $181.97 / $213.80