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Oregon 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 $78 · 10th–90th $35–$950%20%10th90th$78Professionalmedian $44 · 10th–90th $30–$930%10%10th90th$44$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
$41.69 / $89.13 / $131.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $40.74 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $87.10 / $128.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $75.86 / $120.23
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $43.65 / $70.79
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $72.44 / $125.89
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $95.50
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $42.66 / $70.79
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $75.86 / $114.82
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $81.28 / $117.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $83.18 / $123.03