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Washington, DC 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 $71 · 10th–90th $71–$790%20%40%90th$71Professionalmedian $72 · 10th–90th $62–$890%20%10th90th$72$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
$70.79 / $70.79 / $79.43
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $89.13
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $77.62 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $181.97
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $63.10 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $85.11 / $173.78