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Michigan 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
$53.19 / $60.46 / $60.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $51.03 / $60.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.87 / $75.70 / $75.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.13 / $75.70 / $96.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.82 / $62.63 / $113.18
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.19 / $59.40 / $60.46
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.77 / $58.07 / $66.20
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.66 / $67.28 / $94.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.50 / $69.08 / $85.73