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Massachusetts 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 $162–$2510%20%10th90th$200$100.0$500.0$2.0K$10.0K$50.0K

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
$162.18 / $199.53 / $245.47
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $512.86 / $1,737.80
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $165.96 / $457.09
Health New England
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $776.25 / $1,202.26
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $512.86 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$173.78 / $173.78 / $173.78