go back

South Carolina 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
$50.38 / $50.38 / $57.35
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.64 / $51.00 / $60.10
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.92 / $100.92 / $100.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.15 / $67.76 / $97.27
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.82 / $57.35 / $86.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.98 / $65.98 / $65.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.95 / $71.34 / $87.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.40 / $65.73 / $94.20