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Utah 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 $155 · 10th–90th $135–$1820%20%10th90th$155Professionalmedian $224 · 10th–90th $170–$3160%10%20%10th90th$224$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $151.36 / $181.97
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $223.87 / $316.23