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Maine 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.

Professionalmedian $76 · 10th–90th $62–$1350%20%10th90th$76$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
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $141.25
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $100.00 / $141.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $93.33 / $162.18
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $72.44 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $109.65 / $147.91