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Florida 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 $45 · 10th–90th $27–$3980%10%20%10th90th$45Professionalmedian $38 · 10th–90th $28–$540%10%10th90th$38$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
$26.92 / $38.90 / $398.11
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $52.48
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $51.29 / $57.54
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $44.67 / $56.23
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $44.67 / $57.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $48.98 / $79.43
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $39.81 / $50.12
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $64.57
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $44.67 / $75.86
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $42.66 / $53.70