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Nationwide rates for HCPCS 99424

Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.

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	Facility/Professional	Typical Low	Median	Typical High
Aetna Facility/Professional Facility Modifier Typical Low / Median / Typical High $64.57 / $85.11 / $154.88	Facility	$64.57	$85.11	$154.88
Aetna Facility/Professional Professional Modifier Typical Low / Median / Typical High $58.88 / $72.44 / $97.72	Professional	$58.88	$72.44	$97.72
BCBS Facility/Professional Facility Modifier Typical Low / Median / Typical High $58.88 / $74.13 / $186.21	Facility	$58.88	$74.13	$186.21
BCBS Facility/Professional Professional Modifier Typical Low / Median / Typical High $56.23 / $81.28 / $138.04	Professional	$56.23	$81.28	$138.04
Cigna Facility/Professional Facility Modifier Typical Low / Median / Typical High $114.82 / $263.03 / $724.44	Facility	$114.82	$263.03	$724.44
Cigna Facility/Professional Professional Modifier Typical Low / Median / Typical High $72.44 / $107.15 / $194.98	Professional	$72.44	$107.15	$194.98
United Facility/Professional Facility Modifier Typical Low / Median / Typical High $74.13 / $91.20 / $128.82	Facility	$74.13	$91.20	$128.82
United Facility/Professional Professional Modifier Typical Low / Median / Typical High $67.61 / $95.50 / $162.18	Professional	$67.61	$95.50	$162.18

Nationwide rates for HCPCS 99424

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