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Washington 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
$57.30 / $88.17 / $121.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.66 / $52.39 / $66.58
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.81 / $95.88 / $230.12
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.73 / $109.13 / $369.98
Asuris Northwest Health
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$46.44 / $69.51 / $89.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.01 / $95.58 / $149.99
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.24 / $66.06 / $121.08
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.24 / $64.90 / $115.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.73 / $98.46 / $160.01
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.87 / $115.09 / $120.60
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.81 / $78.81 / $88.47
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.70 / $110.14 / $144.69
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.62 / $92.11 / $136.53
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.56 / $99.19 / $165.71
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.61 / $53.55 / $65.38