go back

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
$63.23 / $70.13 / $126.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.09 / $70.13 / $84.05
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.08 / $86.22 / $131.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $92.01 / $129.28
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.56 / $126.56 / $126.56
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.23 / $70.13 / $1,812.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.00 / $73.08 / $94.16
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.56 / $92.05 / $132.01
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.81 / $79.08 / $89.32
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.81 / $79.08 / $89.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.98 / $100.78 / $157.02