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Kentucky 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 $85 · 10th–90th $65–$1260%10%20%10th90th$85Professionalmedian $71 · 10th–90th $58–$890%10%20%10th90th$71$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
$64.57 / $72.44 / $125.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $57.54 / $74.13
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $79.43 / $109.65
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $83.18 / $109.65
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
$67.61 / $104.71 / $389.05
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $51.29
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $107.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $87.10 / $131.83