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Oregon 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 $135 · 10th–90th $68–$1700%20%10th90th$135Professionalmedian $81 · 10th–90th $63–$1740%10%20%10th90th$81$50.0$100.0$200.0

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
$89.13 / $186.21 / $208.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $75.86 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $165.96 / $218.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $138.04 / $190.55
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $81.28 / $128.82
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $141.25 / $218.78
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $162.18 / $162.18
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $79.43 / $128.82
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $131.83 / $213.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $144.54 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $151.36 / $213.80