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Nebraska 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 $66 · 10th–90th $32–$1380%5%10%10th90th$66Professionalmedian $44 · 10th–90th $29–$950%10%10th90th$44$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
$43.65 / $66.07 / $112.20
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $42.66 / $91.20
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $97.72 / $125.89
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $60.26 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $93.33 / $120.23
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $47.86 / $77.62
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $91.20 / $302.00
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $89.13 / $120.23
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $89.13 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $79.43 / $114.82