go back

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)

Facilitymedian $52 · 10th–90th $40–$620%20%10th90th$52Professionalmedian $51 · 10th–90th $40–$760%10%20%10th90th$51$1.0$5.0$20.0$100.0$500.0

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
$39.81 / $52.48 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $48.98 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $58.88 / $95.50
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $47.86 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $67.61 / $107.15
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $64.57 / $109.65
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $61.66 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $64.57 / $100.00