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Kansas 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 $50 · 10th–90th $1–$600%20%40%10th90th$50Professionalmedian $50 · 10th–90th $39–$650%20%40%10th90th$50$0.1$0.5$2.0$10.0$50.0$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 / $57.54 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.76 / $0.95 / $1.02
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.06 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $74.13 / $93.33
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $63.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $89.13 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $69.18 / $91.20