go back

Minnesota 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 $117 · 10th–90th $52–$4270%10%20%10th90th$117Professionalmedian $87 · 10th–90th $47–$1580%5%10%10th90th$87$50.0$100.0$200.0$500.0

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
$50.12 / $57.54 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $61.66
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$89.13 / $93.33 / $309.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $169.82
BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$56.23 / $89.13 / $138.04
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$154.88 / $223.87 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $154.88 / $263.03
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $218.78 / $426.58
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $154.88 / $213.80
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $125.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $131.83 / $323.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $114.82 / $194.98