Principal care management services for a single high-risk disease, each additional 30 minutes of clinical staff time directed by health care professional, per calendar month
Medicare pricing data for 1,935 providers across 42 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 of clinical staff time directed by health care professional, per calendar month (HCPCS code 99427) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $46.41, but hospitals typically charge $107.10 — a 2.3x 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 $46.41, your out-of-pocket cost would be approximately $9.28. 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 2.3x more than what Medicare allows for this procedure. Medicare actually pays $36.61 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| California | $51 | $127 | 95 | 13,725 | +10.6% |
| Maryland | $50 | $111 | 110 | 1,179 | +8.2% |
| New Jersey | $49 | $100 | 46 | 708 | +6.2% |
| Hawaii | $49 | $68 | 5 | 102 | +5.9% |
| New York | $48 | $103 | 181 | 18,333 | +3.3% |
| Washington | $48 | $132 | 19 | 47 | +2.9% |
| Colorado | $47 | $87 | 101 | 1,273 | +1.7% |
| Wyoming | $47 | $155 | 4 | 159 | +1.2% |
| North Dakota | $46 | $46 | 2 | 251 | -0.4% |
| Florida | $46 | $135 | 89 | 2,324 | -1.7% |
| District of Columbia | $46 | $95 | 4 | 295 | -1.8% |
| Delaware | $46 | $85 | 14 | 537 | -1.8% |
| North Carolina | $46 | $90 | 38 | 450 | -1.8% |
| Nevada | $45 | $153 | 42 | 359 | -2.5% |
| Illinois | $45 | $91 | 97 | 5,764 | -2.6% |
| Arizona | $45 | $132 | 61 | 449 | -2.7% |
| Michigan | $45 | $86 | 68 | 490 | -3.4% |
| South Carolina | $45 | $62 | 26 | 3,797 | -3.7% |
| Utah | $44 | $134 | 14 | 3,765 | -4.1% |
| Oregon | $44 | $116 | 28 | 409 | -4.4% |
| Louisiana | $44 | $104 | 69 | 1,471 | -4.6% |
| Ohio | $44 | $135 | 70 | 1,085 | -4.8% |
| Wisconsin | $44 | $172 | 7 | 48 | -5.7% |
| Alabama | $44 | $57 | 21 | 62 | -5.8% |
| Oklahoma | $44 | $93 | 20 | 1,413 | -6.0% |
| Minnesota | $44 | $118 | 37 | 333 | -6.2% |
| Tennessee | $43 | $98 | 90 | 986 | -6.4% |
| Nebraska | $43 | $92 | 11 | 162 | -6.6% |
| Texas | $43 | $97 | 180 | 5,978 | -6.8% |
| Indiana | $43 | $114 | 63 | 1,086 | -6.9% |
| Mississippi | $43 | $86 | 26 | 526 | -6.9% |
| Kentucky | $43 | $69 | 22 | 679 | -7.3% |
| Virginia | $43 | $120 | 48 | 983 | -7.5% |
| Connecticut | $42 | $104 | 3 | 882 | -8.6% |
| Arkansas | $42 | $108 | 16 | 487 | -8.7% |
| Iowa | $42 | $142 | 16 | 403 | -9.0% |
| New Mexico | $42 | $138 | 5 | 58 | -10.1% |
| Idaho | $41 | $110 | 16 | 179 | -10.9% |
| Kansas | $41 | $87 | 9 | 18 | -11.2% |
| Pennsylvania | $40 | $100 | 34 | 1,757 | -13.9% |
| Missouri | $40 | $85 | 48 | 370 | -14.4% |
| Georgia | $39 | $118 | 42 | 1,252 | -16.2% |
⚠️ 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