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Texas 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 $72 · 10th–90th $60–$1000%20%10th90th$72Professionalmedian $72 · 10th–90th $59–$950%10%20%10th90th$72$50.0$100.0$200.0$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
$60.26 / $67.61 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $72.44 / $91.20
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $83.18 / $91.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $75.86 / $85.11
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $70.79 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $89.13 / $134.90
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$467.74 / $467.74 / $467.74
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $512.86 / $512.86
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $95.50
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $114.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $95.50
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $89.13 / $134.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $128.82 / $128.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $87.10 / $123.03
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $89.13 / $107.15