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Ohio 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 $76 · 10th–90th $58–$1020%20%10th90th$76Professionalmedian $72 · 10th–90th $58–$1070%10%20%10th90th$72$1.0$5.0$20.0$100.0$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
$57.54 / $75.86 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $70.79 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $83.18 / $134.90
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $70.79 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $147.91
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $91.20 / $151.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $89.13 / $169.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $93.33 / $138.04