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Oregon 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 $93 · 10th–90th $49–$1200%20%10th90th$93Professionalmedian $58 · 10th–90th $44–$1290%10%10th90th$58$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
$61.66 / $128.82 / $154.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $117.49 / $162.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $93.33 / $134.90
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $57.54 / $93.33
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $102.33 / $158.49
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $120.23 / $120.23
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $54.95 / $89.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $93.33 / $147.91
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $102.33 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $107.15 / $154.88