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North Carolina 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 $79 · 10th–90th $63–$1120%20%10th90th$79Professionalmedian $74 · 10th–90th $60–$1050%20%10th90th$74$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
$72.44 / $79.43 / $190.55
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $104.71
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $169.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $169.82
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $95.50 / $147.91
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86