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Pennsylvania rates for HCPCS 99484

Care management services for behavioral health conditions, at least 20 minutes of clinical staff time, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of applicable validated rating scales, behavioral health care planning in relation to behavioral/psychiatric health problems, including revision for patients who are not progressing or whose status changes, facilitating and coordinating treatment such as psychotherapy, pharmacotherapy, counseling and/or psychiatric consultation, and continuity of care with a designated member of the care team.

Facilitymedian $66 · 10th–90th $66–$660%50%100%$66Professionalmedian $38 · 10th–90th $23–$600%10%10th90th$38$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $37.15 / $57.54
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $52.48 / $60.26
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$36.31 / $36.31 / $36.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $58.88 / $93.33
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $52.48 / $81.28
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $79.43 / $120.23
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $56.23 / $100.00
Highmark BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $64.57
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.91 / $38.02 / $63.10
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $52.48 / $61.66
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$37.15 / $53.70 / $85.11
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$12.88 / $28.18 / $42.66
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $47.86 / $77.62