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Iowa 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)

Facilitymedian $69 · 10th–90th $49–$1230%10%10th90th$69Professionalmedian $51 · 10th–90th $42–$740%10%20%10th90th$51$50.0$100.0$200.0

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
$52.48 / $107.15 / $123.03
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $112.20 / $141.25
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $61.66 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $66.07 / $229.09
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $97.72 / $323.59
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $100.00 / $147.91
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $83.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $70.79 / $125.89
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $72.44 / $87.10