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Wisconsin rates for HCPCS G2064

Comprehensive care management services for a single high risk disease, e.g., principal care management, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements: one complex chronic condition lasting at least 3 months, which is the focus of the care plan, the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization, the condition requires development 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

Facilitymedian $269 · 10th–90th $91–$4270%20%10th90th$269Professionalmedian $135 · 10th–90th $81–$1820%10%10th90th$135$100.0$200.0$500.0

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
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $269.15 / $426.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $134.90 / $181.97
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $223.87 / $323.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $58.88 / $87.10
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $125.89
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $407.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $85.11 / $102.33