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Texas 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 $135 · 10th–90th $48–$2880%10%20%10th90th$135Professionalmedian $117 · 10th–90th $49–$1860%10%10th90th$117$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
$46.77 / $50.12 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $123.03 / $186.21
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $70.79 / $128.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $208.93 / $380.19
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $75.86 / $77.62
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $87.10 / $144.54
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $151.36
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$446.68 / $446.68 / $446.68
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$549.54 / $549.54 / $549.54
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $107.15 / $181.97
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $123.03 / $190.55
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $64.57 / $85.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $81.28
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $109.65 / $194.98
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $85.11 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $83.18 / $141.25
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $70.79 / $85.11