go back

Illinois 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 $60 · 10th–90th $32–$980%10%20%10th90th$60Professionalmedian $41 · 10th–90th $29–$630%10%10th90th$41$50.0$100.0$200.0$500.0

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
$32.36 / $46.77 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $38.02 / $53.70
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $66.07 / $67.61
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$138.04 / $363.08 / $691.83
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $50.12 / $63.10
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
$38.90 / $56.23 / $85.11
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $57.54 / $151.36
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $43.65 / $67.61
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $53.70 / $81.28