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Maine 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 $81 · 10th–90th $63–$1200%20%10th90th$81Professionalmedian $85 · 10th–90th $46–$1450%5%10th90th$85$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
$63.10 / $81.28 / $120.23
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $81.28 / $138.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $64.57 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $95.50 / $165.96
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $109.65 / $181.97
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $81.28 / $114.82
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $89.13 / $147.91
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $102.33 / $162.18