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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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$35.39 / $53.40 / $78.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.86 / $37.86 / $51.81
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.86 / $100.00 / $174.80
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.46 / $63.58 / $218.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$92.60 / $129.63 / $275.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.58 / $52.63 / $61.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.69 / $64.17 / $103.44
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.69 / $70.00 / $6,679.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.39 / $57.67 / $92.51
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.42 / $70.04 / $128.69
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $174.80 / $174.80
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.74 / $84.20 / $298.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.25 / $69.67 / $129.61