Bundled Payments for Care Improvement Advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a BPCI Advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code
Rates data updated October 2026.
How much does Home Visit for Patient Assessment (BPCI Advanced) cost?
$44.67
Typical physician fee. In New Hampshire, October 2026.
Insurers have agreed to pay about $44.67 for this service. Most negotiated rates run $41.69 to $51.29.
These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.
How much rates vary
Professionalmedian $45 · 10th to 90th $42 to $83
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Aetna
Setting
Professional
Modifier
None
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
Professional
None
$44.67
$44.67
$44.67
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$22.39
Median
$22.39
Typical High
$22.39
Professional
52 · Reduced service
$22.39
$22.39
$22.39
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$9.12
Median
$9.12
Typical High
$9.12
Professional
53 · Discontinued
$9.12
$9.12
$9.12
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$6.76
Median
$6.76
Typical High
$6.76
Professional
55 · Aftercare only
$6.76
$6.76
$6.76
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$4.47
Median
$4.47
Typical High
$4.47
Professional
56 · Pre-op care only
$4.47
$4.47
$4.47
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$38.90
Median
$51.29
Typical High
$74.13
Professional
None
$38.90
$51.29
$74.13
Cigna
Setting
Professional
Modifier
None
Typical Low
$46.77
Median
$46.77
Typical High
$56.23
Professional
None
$46.77
$46.77
$56.23
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$41.69
Median
$41.69
Typical High
$97.72
Professional
None
$41.69
$41.69
$97.72
United
Setting
Professional
Modifier
None
Typical Low
$45.71
Median
$70.79
Typical High
$112.20
Professional
None
$45.71
$70.79
$112.20
1 more rate with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
Insurance Carrier
Facility/Professional
Modifier
Typical LowTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
MedianTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Typical HighTypical Low is the 10th percentile of the published rates, Median the 50th, and Typical High the 90th. One in ten rates falls below Typical Low, and one in ten falls above Typical High.
Well Sense
Setting
Facility
Modifier
54 · Surgery only + HN · Bachelor's level
Typical Low
$31.62
Median
$31.62
Typical High
$31.62
Facility
54 · Surgery only + HN · Bachelor's level
$31.62
$31.62
$31.62
Where New Hampshire sits
The same service costs 2.6 times more in North Dakota than in Ohio. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.