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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)

Facilitymedian $51 · 10th–90th $42–$720%10%20%10th90th$51Professionalmedian $50 · 10th–90th $41–$660%10%20%10th90th$50$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
$41.69 / $47.86 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $61.66
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $60.26 / $70.79
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $51.29 / $63.10
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $47.86 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $63.10 / $95.50
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $67.61
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $77.62
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $67.61
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $63.10 / $95.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $91.20 / $91.20
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $61.66 / $89.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $63.10 / $74.13