go back

New Hampshire 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 $60 · 10th–90th $48–$830%20%10th90th$60Professionalmedian $56 · 10th–90th $43–$1150%10%10th90th$56$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $60.26 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $51.29 / $70.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $83.18 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $89.13 / $141.25
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $70.79 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $87.10 / $151.36
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $52.48