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HCPCS 99215

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more

Reported by 12 hospitals in the network under the case rate methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects a negotiated flat case rate paid per episode of care, rather than itemized charges.

National pricing summary

Low

$109

Average

$254

Median

$233

High

$668

Hospitals reporting this code

#HospitalLocation
1Northwest Medical Foundation Of TillamookTillamook, OR$116$116$116$482—
2Ukiah Adventist HospitalUkiah, CA$82$160$169$505$28
3Adventist Health Medical Center TehachapiTehachapi, CA$82$214$214$685$5
4Sonora Community HospitalSonora, CA$82$241$255$766$104
5Glendale Adventist Medical CenterGlendale, CA$82$646$668$2.0k$81
6Adventist Health DelanoDelano, CA$82$266$266$335—
7Reedley Community HospitalReedley, CA$54$168$162$676$8
8San Joaquin Community HospitalBakersfield, CA$82$279$280$503$33
9Lodi Memorial Hospital Association IncLodi, CA$82$343$343$380$17
10Hanford Community HospitalHanford, CA$82$222$229$403$28
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