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Ohio rates for HCPCS 99253

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 45 minutes must be met or exceeded.

Facilitymedian $95 · 10th–90th $71–$1740%20%10th90th$95Professionalmedian $123 · 10th–90th $79–$2040%10%10th90th$123$2.0$10.0$50.0$200.0$1.0K

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
$70.79 / $95.50 / $173.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $123.03 / $208.93
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $102.33 / $141.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $123.03 / $181.97
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $114.82 / $144.54
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $128.82 / $223.87
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $134.90 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $131.83 / $199.53
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $154.88 / $154.88
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $131.83 / $208.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $79.43 / $114.82
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $100.00 / $138.04
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $125.89 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $123.03 / $194.98