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Tennessee 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 $589 · 10th–90th $83–$5890%50%10th$589Professionalmedian $112 · 10th–90th $72–$2000%10%10th90th$112$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
$74.13 / $104.71 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $199.53
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $114.82 / $186.21
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $131.83 / $213.80
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $128.82 / $190.55
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$588.84 / $588.84 / $588.84
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $741.31
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $128.82 / $181.97
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $123.03 / $190.55