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Massachusetts 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 $76–$1950%20%40%10th90th$85Professionalmedian $78 · 10th–90th $62–$1660%20%10th90th$78$50.0$200.0$1.0K$5.0K$20.0K

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
$75.86 / $83.18 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $89.13
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $177.83 / $467.74
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $107.15 / $229.09
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$85.11 / $97.72 / $194.98
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $83.18 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $134.90 / $190.55
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $89.13 / $177.83
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $97.72 / $147.91
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $104.71 / $186.21
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $177.83 / $467.74
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $107.15 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$81.28 / $112.20 / $239.88