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Nebraska 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 $93 · 10th–90th $47–$1380%10%20%10th90th$93Professionalmedian $51 · 10th–90th $42–$1000%20%10th90th$51$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
$53.70 / $93.33 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $48.98 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $57.54 / $57.54
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $83.18 / $114.82
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$97.72 / $114.82 / $141.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $56.23 / $95.50
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $114.82 / $371.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $112.20 / $147.91
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $114.82 / $134.90
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $104.71 / $144.54