go back

Indiana 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 $87 · 10th–90th $38–$1150%20%10th90th$87Professionalmedian $71 · 10th–90th $58–$930%20%10th90th$71$20.0$50.0$100.0$200.0

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 / $87.10 / $114.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $93.33
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $104.71 / $114.82
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $21.88 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $33.11 / $77.62
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $69.18 / $75.86
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $83.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $89.13 / $114.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $85.11 / $123.03