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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)

Facilitymedian $60 · 10th–90th $52–$1320%20%40%10th90th$60Professionalmedian $54 · 10th–90th $42–$1120%20%10th90th$54$20.0$100.0$500.0$2.0K$10.0K$50.0K

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 / $60.26 / $95.50
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $51.29 / $61.66
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $123.03 / $323.59
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $75.86 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$58.88 / $70.79 / $131.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $60.26 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $93.33 / $138.04
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $63.10 / $120.23
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $69.18 / $104.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $74.13 / $131.83
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $123.03 / $323.59
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $75.86 / $165.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $79.43 / $165.96