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Michigan 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 $78 · 10th–90th $65–$780%50%10th$78Professionalmedian $102 · 10th–90th $58–$1910%5%10%10th90th$102$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
$64.57 / $77.62 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $104.71 / $190.55
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $91.20 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $109.65
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $120.23
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $93.33 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $141.25
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $194.98
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $93.33 / $173.78
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $74.13 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $93.33 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $173.78