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Virginia 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 $79 · 10th–90th $63–$1200%20%10th90th$79Professionalmedian $72 · 10th–90th $60–$1050%20%10th90th$72$20.0$100.0$500.0$2.0K$10.0K

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
$70.79 / $79.43 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $89.13 / $120.23
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $81.28 / $109.65
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $95.50 / $138.04
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $77.62 / $112.20
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $104.71
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $95.50 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $107.15 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $104.71 / $104.71
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $97.72 / $162.18