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North Carolina 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 $56 · 10th–90th $44–$810%20%10th90th$56Professionalmedian $52 · 10th–90th $41–$740%20%10th90th$52$50.0$100.0$200.0

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
$51.29 / $57.54 / $134.90
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $51.29 / $61.66
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $53.70 / $74.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $74.13 / $117.49
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $53.70 / $69.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $69.18 / $104.71
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54