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North Carolina 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 $30–$650%10%20%10th90th$42Professionalmedian $40 · 10th–90th $28–$650%10%10th90th$40$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
$33.88 / $45.71 / $109.65
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $38.02 / $53.70
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$24.55 / $41.69 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $56.23 / $93.33
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $40.74 / $56.23
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $51.29 / $81.28
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $218.78 / $218.78
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00