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Wisconsin 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 $46 · 10th–90th $33–$1150%10%20%10th90th$46Professionalmedian $46 · 10th–90th $30–$1050%10%10th90th$46$10.0$20.0$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
$33.11 / $66.07 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.18 / $38.90 / $64.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $57.54 / $112.20
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $147.91 / $234.42
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $100.00 / $134.90
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.11 / $43.65 / $64.57
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $89.13 / $141.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$32.36 / $43.65 / $66.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $97.72 / $302.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $53.70 / $97.72
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $72.44 / $138.04
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$67.61 / $67.61 / $218.78
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $97.72 / $302.00
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $56.23
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $70.79 / $97.72
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $70.79 / $123.03