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Massachusetts 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
$52.39 / $76.62 / $91.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $51.20 / $61.99
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.70 / $123.91 / $250.85
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.29 / $79.70 / $322.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.41 / $75.81 / $148.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.65 / $60.48 / $71.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.16 / $90.95 / $126.93
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.69 / $79.88 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.29 / $66.87 / $111.73
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.50 / $95.20 / $153.37
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $250.85 / $250.85
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.55 / $106.38 / $369.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.66 / $84.95 / $154.77