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Virginia 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)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.71 / $47.10 / $47.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.71 / $36.96 / $47.85
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.92 / $42.09 / $60.22
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.22 / $36.22 / $50.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.43 / $47.43 / $47.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.35 / $51.01 / $79.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.97 / $50.18 / $67.84
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.71 / $40.20 / $61.10
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.27 / $80.62 / $85.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.24 / $44.02 / $150.21
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.79 / $58.87 / $204.22
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.90 / $55.81 / $96.43