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Indiana 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 $42 · 10th–90th $16–$710%20%10th90th$42Professionalmedian $37 · 10th–90th $27–$540%10%10th90th$37$10.0$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
$37.15 / $44.67 / $70.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $67.61 / $75.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9.33 / $9.33 / $30.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$9.33 / $22.39 / $44.67
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $33.11 / $36.31
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $30.90 / $30.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $47.86 / $66.07
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
$33.88 / $46.77 / $69.18