go back

Texas 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 $200 · 10th–90th $107–$6310%20%10th90th$200Professionalmedian $166 · 10th–90th $107–$4470%10%10th90th$166$10.0$20.0$50.0$100.0$200.0$500.0$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
$104.71 / $109.65 / $186.21
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $457.09
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $134.90 / $239.88
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $467.74 / $851.14
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $131.83 / $234.42
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $165.96 / $251.19
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $158.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $199.53 / $331.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $1,000.00 / $1,000.00
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $190.55 / $316.23
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $169.82 / $309.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $114.82 / $151.36
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $123.03 / $138.04
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $199.53 / $331.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $194.98 / $338.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $165.96 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $181.97 / $288.40
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $141.25 / $165.96