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Maryland 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 $74–$1170%20%10th90th$87Professionalmedian $72 · 10th–90th $59–$910%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
$87.10 / $87.10 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $70.79 / $87.10
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $77.62 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $93.33 / $151.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $72.44 / $104.71
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $87.10 / $120.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $93.33 / $144.54
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $123.03 / $141.25