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Wisconsin 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 $79 · 10th–90th $55–$1510%10%20%10th90th$79Professionalmedian $115 · 10th–90th $55–$2400%5%10th90th$115$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
$54.95 / $72.44 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $109.65 / $239.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $107.15 / $213.80
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $97.72 / $138.04
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $177.83 / $204.17
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $89.13 / $154.88
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $173.78 / $208.93
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $87.10 / $154.88
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $141.25 / $524.81
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $41.69 / $85.11
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $162.18 / $380.19
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $165.96 / $229.09
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $446.68 / $446.68
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $363.08 / $549.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $134.90 / $134.90
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $218.78 / $239.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $114.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $173.78 / $239.88