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Ohio 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 $37 · 10th–90th $27–$490%20%10th90th$37Professionalmedian $37 · 10th–90th $27–$580%10%10th90th$37$0.5$2.0$10.0$50.0$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
$26.92 / $37.15 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$26.92 / $36.31 / $48.98
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $53.70 / $77.62
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $46.77 / $74.13
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$22.39 / $33.11 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $48.98 / $79.43
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $47.86 / $79.43
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $53.70 / $89.13
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $48.98 / $75.86