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Wisconsin 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 $123 · 10th–90th $85–$4680%10%20%10th90th$123Professionalmedian $135 · 10th–90th $98–$3310%10%20%10th90th$135$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
$85.11 / $114.82 / $245.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $125.89 / $281.84
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$128.82 / $128.82 / $128.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $194.98 / $363.08
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $407.38 / $645.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $338.84 / $446.68
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $269.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $147.91 / $269.15
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $199.53 / $331.13
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $302.00
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$190.55 / $190.55 / $263.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $323.59 / $446.68
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $251.19 / $794.33
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $331.13 / $794.33
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$234.42 / $389.05 / $501.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $123.03 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $173.78 / $338.84