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Michigan 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 $83 · 10th–90th $76–$1120%20%10th90th$83Professionalmedian $74 · 10th–90th $62–$1050%20%10th90th$74$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
$75.86 / $83.18 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $95.50
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $91.20 / $177.83
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $204.17 / $239.88
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $77.62 / $109.65
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $138.04
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
$74.13 / $91.20 / $117.49