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California 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)

Facilitymedian $35 · 10th–90th $28–$870%10%20%10th90th$35Professionalmedian $42 · 10th–90th $29–$850%10%10th90th$42$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
$30.90 / $48.98 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $39.81 / $74.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $51.29 / $109.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$27.54 / $34.67 / $87.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $45.71 / $102.33
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $52.48 / $95.50
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $53.70 / $91.20
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $41.69 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.12 / $44.67 / $74.13
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $42.66 / $70.79
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $54.95 / $91.20
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $54.95 / $75.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $50.12 / $104.71