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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)

Facilitymedian $44 · 10th–90th $32–$690%10%20%10th90th$44Professionalmedian $39 · 10th–90th $28–$560%10%10th90th$39$10.0$50.0$200.0$1.0K$5.0K

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
$33.11 / $46.77 / $51.29
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $37.15 / $47.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $46.77 / $69.18
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $38.02 / $51.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $51.29 / $77.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $47.86 / $70.79
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $40.74 / $58.88
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $45.71 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $63.10 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.90 / $51.29 / $87.10