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California rates for HCPCS 99425

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; each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.69 / $54.12 / $62.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $51.20 / $62.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.22 / $47.43 / $124.91
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.09 / $54.78 / $101.08
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.10 / $61.52 / $92.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.47 / $69.45 / $122.70
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.53 / $62.89 / $85.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.27 / $57.96 / $105.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.12 / $250.85 / $250.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.24 / $322.24 / $369.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.23 / $60.46 / $83.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.81 / $69.53 / $130.00
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.90 / $64.50 / $87.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.72 / $69.29 / $175.73