go back

Florida 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
$41.80 / $46.82 / $76.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $50.10 / $60.46
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.56 / $49.56 / $49.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.20 / $65.98 / $98.66
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.81 / $42.22 / $54.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.67 / $79.92 / $136.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.42 / $62.64 / $104.24
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.97 / $50.24 / $50.24