go back

Washington 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
$38.71 / $60.12 / $83.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.08 / $40.67 / $59.06
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.42 / $69.79 / $160.47
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.17 / $79.98 / $298.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.80 / $71.56 / $118.46
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.91 / $49.28 / $87.06
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.91 / $48.49 / $81.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.57 / $99.92 / $162.31
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.65 / $78.09 / $95.14
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.42 / $63.42 / $69.79
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.62 / $81.00 / $114.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.17 / $65.45 / $101.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.61 / $81.20 / $133.33
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.59 / $43.07 / $57.02