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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)

Facilitymedian $58 · 10th–90th $47–$1480%20%10th90th$58Professionalmedian $58 · 10th–90th $44–$1350%10%10th90th$58$20.0$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
$47.86 / $95.50 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $51.29 / $64.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $75.86 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $186.21 / $295.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $128.82 / $173.78
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $56.23 / $79.43
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $109.65 / $162.18
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $56.23 / $85.11
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $123.03 / $371.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $61.66 / $134.90
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $93.33 / $158.49
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $323.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $138.04 / $371.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $69.18
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $104.71 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $93.33 / $158.49