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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.00 / $58.07 / $90.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $51.00 / $59.38
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.94 / $59.28 / $126.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.18 / $77.20 / $121.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.14 / $54.01 / $69.68
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.46 / $50.46 / $65.94
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.59 / $75.84 / $119.61
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.88 / $250.85 / $250.85
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.24 / $322.24 / $369.98