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North Dakota 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 $58 · 10th–90th $50–$620%20%40%10th90th$58Professionalmedian $58 · 10th–90th $45–$1260%10%10th90th$58$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
$50.12 / $51.29 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $52.48 / $70.79
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $114.82 / $138.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $128.82 / $181.97
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $57.54 / $87.10
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $114.82 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $102.33 / $144.54