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Massachusetts 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 $89 · 10th–90th $40–$1480%10%10th90th$89Professionalmedian $95 · 10th–90th $50–$1820%5%10%10th90th$95$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
$67.61 / $112.20 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $91.20 / $177.83
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $416.87 / $416.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $102.33 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $100.00 / $169.82
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $52.48 / $91.20
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $77.62 / $123.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $112.20 / $186.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $416.87 / $416.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $102.33 / $288.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $83.18 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $102.33 / $194.98