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Massachusetts 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 $123 · 10th–90th $62–$1820%10%10th90th$123Professionalmedian $120 · 10th–90th $74–$2750%10%10th90th$120$5.0$20.0$100.0$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
$93.33 / $134.90 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $114.82 / $275.42
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $588.84 / $588.84
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $138.04 / $239.88
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $79.43 / $138.04
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $114.82 / $177.83
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $173.78 / $281.84
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $588.84 / $588.84
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $144.54 / $436.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $109.65 / $144.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $144.54 / $288.40