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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)

Facilitymedian $71 · 10th–90th $46–$1100%20%10th90th$71Professionalmedian $51 · 10th–90th $42–$890%20%40%10th90th$51$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$52.48 / $70.79 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $75.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $56.23 / $104.71
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $74.13
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $74.13 / $83.18
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $77.62 / $165.96
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $51.29 / $128.82
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $93.33 / $134.90
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $57.54 / $57.54
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $66.07 / $109.65
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $81.28 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $204.17 / $269.15
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $66.07 / $138.04
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $48.98 / $69.18
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $66.07 / $112.20