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Wisconsin 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
$48.96 / $56.11 / $157.69
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.30 / $51.03 / $60.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.64 / $71.67 / $140.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$159.50 / $186.39 / $285.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.81 / $128.86 / $169.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.63 / $56.52 / $78.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.89 / $56.52 / $80.29
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.48 / $119.70 / $369.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.32 / $61.81 / $132.93
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.63 / $56.52 / $78.55
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.33 / $116.02 / $173.26
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.78 / $96.78 / $230.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.59 / $257.89 / $369.98
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.78 / $104.95 / $124.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.76 / $104.34 / $165.68