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Pennsylvania 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 $50 · 10th–90th $44–$1,8620%20%10th90th$50Professionalmedian $50 · 10th–90th $42–$620%20%40%10th90th$50$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
$43.65 / $50.12 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $50.12 / $60.26
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $63.10 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $67.61 / $97.72
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $102.33
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $102.33
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $50.12
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $50.12 / $60.26
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $56.23 / $64.57
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $50.12 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $64.57 / $102.33