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Kentucky rates for HCPCS 99242

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and straightforward medical decision making. When using total time on the date of the encounter for code selection, 20 minutes must be met or exceeded.

Facilitymedian $55 · 10th–90th $42–$740%20%10th90th$55Professionalmedian $78 · 10th–90th $45–$1410%5%10th90th$78$5.0$10.0$20.0$50.0$100.0$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
$40.74 / $52.48 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $79.43 / $144.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $67.61 / $69.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $47.86 / $77.62
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $58.88 / $85.11
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $79.43 / $109.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $95.50 / $407.38
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $67.61 / $85.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $83.18 / $123.03