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Montana 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 $126 · 10th–90th $71–$1450%20%10th90th$126Professionalmedian $79 · 10th–90th $62–$1260%10%20%10th90th$79$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
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $75.86 / $107.15
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $85.11 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $131.83 / $154.88
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $109.65 / $181.97
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $144.54
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $131.83 / $144.54
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $120.23
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $104.71 / $162.18
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
$102.33 / $131.83 / $158.49