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Michigan 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 $48 · 10th–90th $36–$520%20%10th90th$48Professionalmedian $38 · 10th–90th $29–$520%10%10th90th$38$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
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $48.98
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $66.07 / $77.62
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $54.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $52.48 / $109.65
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $117.49 / $138.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $42.66 / $63.10
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $51.29 / $79.43
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
$37.15 / $48.98 / $64.57