Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional
Medicare pricing data for 3,330 providers across 48 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
Care management services for behavioral health conditions, 20 minutes or more clinical staff time directed by health care professional (HCPCS code 99484) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $38.15, but hospitals typically charge $116.26 — a 3.0x 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 $38.15, your out-of-pocket cost would be approximately $7.63. 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 3.0x more than what Medicare allows for this procedure. Medicare actually pays $29.73 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $48 | $78 | 3 | 173 | +25.7% |
| Kansas | $42 | $61 | 2 | 25 | +10.4% |
| New Jersey | $42 | $132 | 126 | 9,544 | +10.0% |
| Connecticut | $42 | $99 | 13 | 355 | +10.0% |
| California | $42 | $117 | 377 | 32,913 | +9.4% |
| Wyoming | $42 | $108 | 12 | 261 | +9.4% |
| Maryland | $42 | $268 | 65 | 8,843 | +8.8% |
| Illinois | $41 | $87 | 158 | 5,165 | +8.1% |
| Oregon | $40 | $147 | 26 | 3,308 | +6.0% |
| New York | $40 | $114 | 205 | 11,505 | +5.6% |
| Hawaii | $40 | $85 | 6 | 22 | +4.9% |
| Arizona | $39 | $105 | 119 | 6,667 | +3.0% |
| Oklahoma | $39 | $70 | 18 | 1,417 | +2.7% |
| South Carolina | $39 | $83 | 27 | 188 | +2.4% |
| Alabama | $39 | $62 | 15 | 1,221 | +2.3% |
| North Carolina | $39 | $87 | 107 | 1,767 | +2.0% |
| Texas | $39 | $97 | 158 | 14,698 | +2.0% |
| Colorado | $39 | $104 | 122 | 6,646 | +2.0% |
| Nebraska | $39 | $88 | 22 | 69 | +1.8% |
| Washington | $39 | $90 | 29 | 1,971 | +1.8% |
| Massachusetts | $38 | $120 | 47 | 6,888 | +0.8% |
| Michigan | $38 | $77 | 205 | 2,701 | +0.5% |
| Mississippi | $38 | $69 | 14 | 1,233 | -0.3% |
| Louisiana | $38 | $91 | 17 | 1,518 | -0.4% |
| Nevada | $38 | $98 | 40 | 12,321 | -0.4% |
| Florida | $38 | $86 | 155 | 13,298 | -0.5% |
| Georgia | $38 | $83 | 40 | 4,979 | -0.9% |
| Rhode Island | $38 | $119 | 3 | 706 | -1.6% |
| Montana | $37 | $94 | 31 | 79 | -2.5% |
| Delaware | $37 | $81 | 17 | 1,856 | -3.9% |
| New Hampshire | $37 | $120 | 20 | 3,914 | -3.9% |
| Vermont | $37 | $120 | 3 | 3,242 | -3.9% |
| Pennsylvania | $37 | $121 | 478 | 56,093 | -4.0% |
| Minnesota | $36 | $99 | 6 | 63 | -4.5% |
| Indiana | $36 | $85 | 160 | 1,663 | -4.7% |
| Virginia | $36 | $174 | 88 | 5,604 | -5.2% |
| Maine | $36 | $80 | 3 | 718 | -6.2% |
| Ohio | $36 | $107 | 70 | 5,474 | -6.6% |
| West Virginia | $35 | $119 | 17 | 2,922 | -7.5% |
| Wisconsin | $35 | $92 | 26 | 615 | -8.6% |
| Utah | $35 | $95 | 18 | 246 | -8.7% |
| New Mexico | $35 | $119 | 3 | 2,584 | -9.3% |
| Arkansas | $34 | $93 | 11 | 84 | -10.7% |
| Iowa | $34 | $120 | 2 | 1,345 | -11.1% |
| Idaho | $34 | $99 | 16 | 659 | -12.0% |
| Missouri | $31 | $100 | 26 | 3,877 | -18.8% |
| Kentucky | $31 | $110 | 106 | 6,614 | -19.2% |
| Tennessee | $30 | $93 | 57 | 3,195 | -22.1% |
⚠️ 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