Principal care management services for a single high-risk disease, each additional 30 minutes provided personally by qualified health care professional, per calendar month
Medicare pricing data for 188 providers across 20 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, each additional 30 minutes provided personally by qualified health care professional, per calendar month (HCPCS code 99425) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $57.31, but hospitals typically charge $112.83 — a 2.0x 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 $57.31, your out-of-pocket cost would be approximately $11.46. 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 2.0x more than what Medicare allows for this procedure. Medicare actually pays $44.95 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| California | $64 | $126 | 15 | 1,415 | +12.2% |
| District of Columbia | $64 | $102 | 3 | 2,109 | +11.6% |
| New Jersey | $61 | $75 | 13 | 1,386 | +7.2% |
| New York | $60 | $116 | 26 | 1,109 | +5.4% |
| Colorado | $59 | $87 | 6 | 18 | +2.9% |
| New Mexico | $56 | $170 | 2 | 58 | -1.9% |
| Florida | $56 | $217 | 10 | 127 | -2.2% |
| Michigan | $56 | $109 | 3 | 24 | -3.0% |
| North Carolina | $56 | $141 | 17 | 297 | -3.1% |
| Pennsylvania | $53 | $131 | 7 | 63 | -7.5% |
| Delaware | $53 | $106 | 3 | 34 | -8.0% |
| Illinois | $52 | $100 | 12 | 2,902 | -8.6% |
| Connecticut | $52 | $115 | 1 | 133 | -9.9% |
| Utah | $48 | $111 | 5 | 53 | -15.6% |
| Texas | $48 | $164 | 15 | 1,224 | -16.1% |
| Missouri | $48 | $64 | 7 | 93 | -16.8% |
| Georgia | $48 | $117 | 4 | 151 | -17.1% |
| North Dakota | $46 | $118 | 1 | 13 | -19.0% |
| Tennessee | $46 | $150 | 1 | 170 | -20.0% |
| Arizona | $43 | $105 | 4 | 13 | -24.8% |
⚠️ 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