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New York 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
$46.03 / $68.14 / $108.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.25 / $50.74 / $68.14
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.85 / $54.78 / $92.43
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$73.40 / $73.40 / $73.40
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.40 / $73.40 / $83.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.92 / $67.92 / $67.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.50 / $72.20 / $149.36
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.59 / $64.76 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.66 / $95.93 / $143.44
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.83 / $57.10 / $57.10
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.34 / $66.80 / $105.27
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.92 / $67.92 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.46 / $75.27 / $150.77
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.33 / $70.64 / $142.38
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.21 / $57.10 / $72.76
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.34 / $69.66 / $125.09