What do doctors typically charge for Principal Care Management Services for a Single High-risk Disease?

The nationwide median physician charge for Principal Care Management Services for a Single High-risk Disease (CPT 99425) is $115.00. Doctor billed charges vary based on geographic region, setting, and overhead.

What is the standard insurance baseline for CPT 99425?

The standard insurance baseline reimbursement rate is $55.68. This represents the customary allowable amount established across standard fee schedules.

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CPT 99425Medical Service

Principal Care Management Services for a Single High-risk Disease

Principal care management services for a single high-risk disease, each additional 30 minutes provided personally by qualified health care professional, per calendar month. Clinical pricing breakdown and utilization metrics across 45 practicing doctors nationwide.

$115.00

Peer Median Charge

Gross billed rate

$55.68

Standard Baseline

Customary allowable

2.1x

National Markup

Charge vs baseline

Active Physicians

Billing this code

Planning care or already received a bill for CPT 99425?Calculate total facility bundle costs or generate an assertive dispute settlement offer.

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Understanding This Medical Fee

Gross Charge vs Negotiated Payment: The median physician charge for this service is $115.00. However, insured patients almost never pay this full amount directly. Insurers negotiate rates down toward the $55.68 baseline.

Self-Pay & Uninsured Guidance: If you are paying without insurance or out-of-network, request a prompt-pay cash discount. Most medical practices are willing to settle self-pay bills near the customary baseline rate rather than the full gross charge.

Key Questions for Your Doctor's Billing Office:

"Does Dr. [Name] participate in my specific insurance plan network?"
"What is the total self-pay or cash rate for code 99425 if paid upfront?"
"Are there separate facility, anesthesia, or pathology fees associated with this procedure?"