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New York 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 $100 · 10th–90th $66–$1550%20%10th90th$100Professionalmedian $72 · 10th–90th $60–$1290%20%40%10th90th$72$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$74.13 / $102.33 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $114.82
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $89.13 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $141.25
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $109.65 / $223.87
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $75.86 / $181.97
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $131.83 / $194.98
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $77.62 / $77.62
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $151.36
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $112.20 / $131.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$234.42 / $288.40 / $380.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $93.33 / $194.98
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $70.79 / $95.50
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $154.88