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)

Facilitymedian $51 · 10th–90th $33–$1000%20%10th90th$51Professionalmedian $40 · 10th–90th $28–$720%20%10th90th$40$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$38.02 / $54.95 / $100.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $38.02 / $64.57
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $44.67 / $83.18
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $67.61
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $58.88 / $128.82
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$20.42 / $36.31 / $85.11
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $83.18 / $120.23
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $48.98 / $48.98
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $54.95 / $87.10
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $67.61 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $134.90 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$27.54 / $50.12 / $107.15
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $33.11 / $54.95
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $53.70 / $87.10