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Massachusetts rates for HCPCS 99254

Inpatient or observation consultation for a new or established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using total time on the date of the encounter for code selection, 60 minutes must be met or exceeded.

Facilitymedian $195 · 10th–90th $162–$2400%20%40%10th90th$195Professionalmedian $174 · 10th–90th $123–$4170%20%10th90th$174$10.0$50.0$200.0$1.0K$5.0K$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
$162.18 / $204.17 / $239.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $169.82 / $426.58
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $1,000.00
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $257.04 / $338.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $239.88 / $354.81
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $169.82 / $380.19
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $229.09
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $251.19 / $354.81
Health New England
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $1,023.29
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $251.19 / $1,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $138.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $234.42 / $380.19