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Wisconsin 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 $81 · 10th–90th $68–$1950%20%10th90th$81Professionalmedian $81 · 10th–90th $62–$1950%10%20%10th90th$81$20.0$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
$70.79 / $138.04 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $72.44 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $109.65 / $204.17
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $257.04 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $186.21 / $239.88
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $109.65
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $223.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $77.62 / $117.49
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $169.82 / $512.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $85.11 / $194.98
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$85.11 / $134.90 / $229.09
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $138.04 / $467.74
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $199.53 / $512.86
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $97.72
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $141.25 / $169.82
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $131.83 / $218.78