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Nursing Facility Evaluation for Acute Change in Condition

Massachusetts rates for HCPCS G9685

Physician service or other qualified health care professional for the evaluation and management of a beneficiary's acute change in condition in a nursing facility. This service is for a demonstration project

Rates data updated July 2026.

Facilitymedian $501 · 10th–90th $158$7080%10%20%10th90th$501Professionalmedian $191 · 10th–90th $162$3240%20%10th90th$191$100.0$500.0$2.0K$10.0K$50.0K

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
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$199.53
Typical High
$199.53
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$199.53
Typical High
$245.47
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$269.15
Typical High
$524.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$524.81
Typical High
$691.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$234.42
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$173.78
Typical High
$2,951.21
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$218.78
Typical High
$363.08
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$190.55
Typical High
$338.84
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$1,202.26
Typical High
$1,202.26
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$269.15
Typical High
$524.81
United
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$316.23
United
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$269.15
Typical High
$501.19