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New Jersey 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 $34 · 10th–90th $30–$600%20%10th90th$34Professionalmedian $39 · 10th–90th $28–$580%10%10th90th$39$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
$30.20 / $33.88 / $60.26
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $51.29
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $54.95 / $91.20
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $40.74 / $83.18
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $53.70 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$25.70 / $44.67 / $83.18