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Kentucky rates for HCPCS 99243

Office or other outpatient consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded.

Facilitymedian $87 · 10th–90th $66–$1170%20%10th90th$87Professionalmedian $107 · 10th–90th $71–$1740%10%10th90th$107$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 / $83.18 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $107.15 / $173.78
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $109.65 / $144.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $114.82
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $95.50 / $134.90
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $123.03 / $165.96
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $134.90 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $131.83 / $537.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $91.20 / $117.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $114.82 / $173.78