go back

Utah 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 $48 · 10th–90th $36–$480%20%40%10th$48Professionalmedian $39 · 10th–90th $28–$580%10%10th90th$39$50.0$100.0

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
$36.31 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $38.02 / $53.70
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $57.54 / $75.86
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $83.18
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $50.12 / $70.79
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $51.29 / $63.10
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $81.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $47.86 / $70.79