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Massachusetts 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 $107 · 10th–90th $72–$1320%20%40%10th90th$107Professionalmedian $107 · 10th–90th $58–$1820%10%20%10th90th$107$5.0$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$72.44 / $107.15 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $107.15 / $177.83
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $123.03 / $549.54
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $123.03 / $173.78
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $117.49 / $162.18
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $97.72 / $162.18
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $79.43 / $114.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $125.89 / $181.97
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $123.03 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $112.20 / $199.53