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Maine 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)

Professionalmedian $41 · 10th–90th $29–$690%10%10th90th$41$50.0$100.0

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
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $38.02 / $53.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $53.70 / $85.11
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $56.23 / $85.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $51.29 / $100.00
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $39.81 / $53.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $66.07 / $85.11