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Nationwide rates for HCPCS 99427

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 of clinical staff time directed by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure)

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	Facility/Professional	Typical Low	Median	Typical High
Aetna Facility/Professional Facility Modifier Typical Low / Median / Typical High $30.90 / $46.77 / $85.11	Facility	$30.90	$46.77	$85.11
Aetna Facility/Professional Professional Modifier Typical Low / Median / Typical High $28.18 / $37.15 / $52.48	Professional	$28.18	$37.15	$52.48
BCBS Facility/Professional Facility Modifier Typical Low / Median / Typical High $27.54 / $34.67 / $87.10	Facility	$27.54	$34.67	$87.10
BCBS Facility/Professional Professional Modifier Typical Low / Median / Typical High $27.54 / $43.65 / $75.86	Professional	$27.54	$43.65	$75.86
Cigna Facility/Professional Facility Modifier Typical Low / Median / Typical High $54.95 / $154.88 / $426.58	Facility	$54.95	$154.88	$426.58
Cigna Facility/Professional Professional Modifier Typical Low / Median / Typical High $36.31 / $57.54 / $120.23	Professional	$36.31	$57.54	$120.23
United Facility/Professional Facility Modifier Typical Low / Median / Typical High $37.15 / $53.70 / $75.86	Facility	$37.15	$53.70	$75.86
United Facility/Professional Professional Modifier Typical Low / Median / Typical High $33.11 / $51.29 / $89.13	Professional	$33.11	$51.29	$89.13

Nationwide rates for HCPCS 99427

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