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New York rates for HCPCS 99416

Prolonged clinical staff service (the service beyond the highest time in the range of total time of the service) during an evaluation and management service in the office or outpatient setting, direct patient contact with physician supervision; each additional 30 minutes (List separately in addition to code for prolonged service)

Professionalmedian $7 · 10th–90th $4–$230%10%10th90th$7$0.5$2.0$10.0$50.0

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
Professional
Modifier
Typical Low / Median / Typical High
$3.98 / $5.01 / $12.30
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.02 / $12.02 / $12.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3.47 / $4.07 / $10.00
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7.08 / $7.08 / $7.08
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $7.94 / $21.38
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.80 / $18.20 / $26.30
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.27 / $10.23 / $23.44
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6.03 / $6.03 / $6.03
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.90 / $6.03 / $21.38
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4.79 / $6.17 / $10.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.89 / $15.14 / $27.54
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.75 / $10.23 / $19.50