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New York 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 $95 · 10th–90th $62–$2000%20%40%10th90th$95Professionalmedian $115 · 10th–90th $58–$1860%20%40%10th90th$115$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
$64.57 / $95.50 / $199.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $123.03 / $194.98
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $117.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $64.57 / $147.91
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $109.65 / $295.12
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $102.33 / $269.15
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $144.54
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $95.50 / $141.25
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.02 / $0.03 / $0.05
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $100.00 / $245.47
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $151.36
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $63.10 / $245.47
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $93.33 / $190.55