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Colorado 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.

Facilitymedian $81 · 10th–90th $72–$810%20%40%10th$81Professionalmedian $72 · 10th–90th $60–$1020%10%20%10th90th$72$20.0$50.0$100.0$200.0$500.0

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
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $81.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $89.13 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $109.65 / $147.91
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $295.12 / $707.95
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $89.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $141.25
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $120.23 / $177.83