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New Mexico 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 $43–$950%10%10th90th$56Professionalmedian $49 · 10th–90th $40–$660%10%20%10th90th$49$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
$69.18 / $72.44 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $47.86 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $56.23 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $74.13 / $109.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $64.57
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $72.44 / $109.65
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $81.28 / $120.23