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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)

Facilitymedian $52 · 10th–90th $34–$950%5%10%10th90th$52Professionalmedian $44 · 10th–90th $31–$810%10%10th90th$44$50.0$100.0$200.0

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
$39.81 / $72.44 / $107.15
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $38.90 / $60.26
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $77.62
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $64.57 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $72.44 / $120.23
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $48.98 / $85.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $47.86 / $77.62
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $60.26
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$57.54 / $95.50 / $95.50
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $69.18
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $69.18 / $117.49
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $64.57 / $97.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $112.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $61.66 / $117.49