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Ohio 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
$39.81 / $52.48 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $48.98 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $60.26 / $100.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $58.88 / $91.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $47.86 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $64.57 / $97.72
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $66.07 / $107.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $61.66 / $117.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $66.07 / $100.00