go back

New York 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.32 / $48.36 / $85.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.67 / $38.71 / $56.71
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.79 / $53.79 / $53.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.76 / $43.95 / $74.29
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.85 / $49.85 / $49.85
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.85 / $49.85 / $67.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.43 / $47.43 / $47.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.49 / $54.71 / $116.30
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$21.20 / $43.46 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.37 / $81.95 / $123.74
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.37 / $48.78 / $48.78
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.85 / $54.63 / $81.51
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.43 / $47.43 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.78 / $58.37 / $116.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.93 / $57.83 / $118.34
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.38 / $48.78 / $54.84
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.70 / $53.24 / $87.98