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Ohio 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 $68 · 10th–90th $50–$1230%20%10th90th$68Professionalmedian $98 · 10th–90th $54–$1620%5%10%10th90th$98$1.0$5.0$20.0$100.0$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
$50.12 / $67.61 / $144.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $100.00 / $169.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $87.10 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $89.13 / $128.82
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $102.33
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $158.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $89.13 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $89.13 / $141.25
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $109.65 / $109.65
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $141.25
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $54.95 / $77.62
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $72.44 / $97.72
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $89.13 / $158.49
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $123.03