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Nationwide rates for HCPCS 99252

Inpatient or observation 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, 35 minutes must be met or exceeded.

Facilitymedian $89 · 10th–90th $58$1950%20%10th90th$89Professionalmedian $110 · 10th–90th $56$1860%20%40%10th90th$110$0.0$0.2$2.0$20.0$200.0$2.0K$20.0K

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
$50.12 / $85.11 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $112.20 / $186.21
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $194.98
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $85.11 / $151.36
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $97.72 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $75.86 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $91.20 / $173.78