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Texas 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
$39.93 / $48.75 / $76.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.61 / $48.75 / $61.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.64 / $52.95 / $61.97
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$43.65 / $47.77 / $60.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.00 / $61.95 / $96.95
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.12 / $250.85 / $250.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$322.24 / $322.24 / $369.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.13 / $51.27 / $67.22
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.09 / $73.59 / $95.88
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.27 / $59.27 / $70.98
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.13 / $51.12 / $66.77
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.85 / $63.01 / $106.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.10 / $62.80 / $93.96
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.24 / $57.39 / $79.87