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Pennsylvania 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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $70.79 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $72.44 / $93.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $87.10 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $93.33 / $131.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $144.54 / $144.54
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $81.28 / $144.54
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $100.00 / $1,862.09
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $74.13 / $141.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.84 / $79.43 / $758.58
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.91 / $81.28 / $407.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.18 / $93.33 / $147.91