Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month.
Medicare pricing data for 681 providers across 35 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Principal care management services for a single high-risk disease, first 30 minutes provided personally by qualified health care professional, per calendar month. (HCPCS code 99424) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $80.22, but hospitals typically charge $153.94 — a 1.9x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $80.22, your out-of-pocket cost would be approximately $16.04. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 1.9x more than what Medicare allows for this procedure. Medicare actually pays $62.36 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $88 | $132 | 5 | 1,284 | +9.2% |
| New Jersey | $87 | $146 | 32 | 4,287 | +8.5% |
| California | $87 | $161 | 64 | 13,786 | +7.9% |
| New York | $85 | $141 | 92 | 6,580 | +5.6% |
| Maryland | $82 | $168 | 14 | 144 | +2.7% |
| Indiana | $82 | $102 | 5 | 616 | +1.7% |
| Florida | $81 | $160 | 47 | 3,821 | +0.9% |
| Pennsylvania | $80 | $276 | 37 | 1,567 | -0.0% |
| Virginia | $80 | $140 | 12 | 360 | -0.5% |
| Massachusetts | $80 | $227 | 1 | 18 | -0.7% |
| Nevada | $79 | $151 | 3 | 218 | -0.9% |
| New Mexico | $79 | $267 | 3 | 165 | -1.9% |
| Louisiana | $78 | $241 | 7 | 1,467 | -2.3% |
| Michigan | $77 | $113 | 21 | 1,223 | -3.4% |
| Colorado | $77 | $140 | 22 | 67 | -3.7% |
| Georgia | $77 | $124 | 23 | 2,105 | -4.3% |
| North Carolina | $76 | $220 | 30 | 916 | -5.1% |
| Illinois | $75 | $126 | 60 | 9,097 | -6.5% |
| Washington | $75 | $106 | 5 | 246 | -6.7% |
| Delaware | $74 | $218 | 5 | 156 | -7.3% |
| Connecticut | $74 | $147 | 7 | 590 | -7.3% |
| Montana | $73 | $155 | 1 | 17 | -8.6% |
| Oregon | $72 | $227 | 8 | 110 | -9.9% |
| Ohio | $72 | $183 | 7 | 55 | -10.1% |
| Texas | $71 | $158 | 45 | 2,683 | -11.7% |
| Kentucky | $68 | $96 | 11 | 30 | -14.7% |
| South Carolina | $68 | $228 | 8 | 73 | -14.7% |
| Utah | $68 | $149 | 9 | 65 | -14.9% |
| West Virginia | $68 | $161 | 6 | 96 | -15.3% |
| Arkansas | $67 | $140 | 8 | 219 | -16.4% |
| North Dakota | $67 | $163 | 3 | 44 | -16.8% |
| Arizona | $67 | $165 | 17 | 2,296 | -17.0% |
| Wyoming | $66 | $260 | 2 | 54 | -17.8% |
| Tennessee | $64 | $100 | 3 | 68 | -19.8% |
| Missouri | $63 | $151 | 24 | 1,293 | -20.9% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber