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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.14 / $50.74 / $91.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $49.15 / $58.07
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.35 / $62.62 / $94.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.85 / $66.09 / $93.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.61 / $91.61 / $91.61
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.14 / $50.74 / $1,812.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.14 / $50.10 / $61.99
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.39 / $66.69 / $95.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.63 / $56.50 / $64.36
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.63 / $56.50 / $64.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.27 / $73.44 / $113.18