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Illinois 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 $98 · 10th–90th $68–$1700%10%10th90th$98Professionalmedian $81 · 10th–90th $62–$1050%10%10th90th$81$50.0$100.0$200.0$500.0$1.0K

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
$67.61 / $93.33 / $169.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $104.71
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $97.72
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $758.58 / $1,445.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $93.33 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $107.15 / $144.54
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $97.72 / $234.42
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $93.33 / $112.20
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$81.28 / $81.28 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $100.00 / $147.91