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Pennsylvania rates for HCPCS G9987

Bundled Payments for Care Improvement Advanced (BPCI Advanced) model home visit for patient assessment performed by clinical staff for an individual not considered homebound, including, but not necessarily limited to patient assessment of clinical status, safety/fall prevention, functional status/ambulation, medication reconciliation/management, compliance with orders/plan of care, performance of activities of daily living, and ensuring beneficiary connections to community and other services; for use only for a BPCI Advanced model episode of care; may not be billed for a 30-day period covered by a transitional care management code

Facilitymedian $36 · 10th–90th $36–$590%50%90th$36Professionalmedian $38 · 10th–90th $32–$510%50%10th90th$38$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$36.31 / $36.31 / $36.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $38.02 / $50.12
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $47.86 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $46.77 / $46.77
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $45.71 / $81.28
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$36.31 / $36.31 / $36.31
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $38.02 / $51.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $47.86 / $58.88
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $47.86 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $51.29 / $79.43