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Washington, DC 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 $33 · 10th–90th $33–$470%20%40%90th$33Professionalmedian $37 · 10th–90th $28–$470%10%10th90th$37$20.0$50.0$100.0

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
$33.11 / $33.11 / $46.77
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $46.77
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $36.31 / $48.98
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $109.65
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $39.81 / $60.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $45.71 / $100.00