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Maryland 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 $65 · 10th–90th $52–$890%20%10th90th$65Professionalmedian $50 · 10th–90th $41–$650%20%10th90th$50$50.0$100.0

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
$60.26 / $60.26 / $69.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $61.66
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $109.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $51.29 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $64.57 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $64.57 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $89.13 / $97.72