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Pennsylvania 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 $49 · 10th–90th $29–$1,8620%20%10th90th$49Professionalmedian $38 · 10th–90th $28–$520%20%10th90th$38$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
$28.84 / $48.98 / $1,412.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $48.98
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $53.70 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $51.29 / $77.62
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $47.86 / $89.13
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $28.84 / $39.81
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $51.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21.88 / $33.88 / $51.29
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $33.88 / $47.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $50.12 / $77.62