go back

Massachusetts 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 $49 · 10th–90th $35–$930%20%40%10th90th$49Professionalmedian $41 · 10th–90th $29–$850%20%10th90th$41$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$34.67 / $48.98 / $83.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $51.29
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $85.11 / $218.78
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $56.23 / $131.83
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $48.98 / $95.50
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $50.12 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $66.07 / $114.82
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$19.95 / $46.77 / $87.10
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $61.66 / $93.33
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $60.26 / $112.20
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$37.15 / $85.11 / $218.78
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $56.23 / $131.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $54.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $64.57 / $141.25