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New York rates for HCPCS 99305

Initial nursing facility care, per day, for the evaluation and management of a 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, 35 minutes must be met or exceeded.

Facilitymedian $162 · 10th–90th $115–$2630%20%10th90th$162Professionalmedian $132 · 10th–90th $91–$2570%20%10th90th$132$0.1$1.0$10.0$100.0$1.0K$10.0K

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
$128.82 / $165.96 / $251.19
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $131.83 / $257.04
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$128.82 / $147.91 / $147.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.79 / $109.65 / $234.42
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $50,118.72 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $173.78 / $616.60
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.10 / $128.82 / $309.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $245.47 / $416.87
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $125.89 / $125.89
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $114.82 / $245.47
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $138.04 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $416.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $151.36 / $281.84
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $128.82 / $257.04
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $128.82 / $380.19