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Idaho 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 $58 · 10th–90th $45–$2190%10%20%10th90th$58Professionalmedian $52 · 10th–90th $42–$870%10%20%10th90th$52$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
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $51.29 / $70.79
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$194.98 / $239.88 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $100.00 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $114.82
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $54.95 / $85.11
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $77.62 / $114.82
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $79.43 / $95.50
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $57.54 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $74.13 / $102.33