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Alabama rates for HCPCS 99426

Principal care management services, for a single high-risk disease, with the following required elements: one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death, the condition requires development, monitoring, or revision of disease-specific care plan, the condition requires frequent adjustments in the medication regimen and/or the management of the condition is unusually complex due to comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care; first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month.

Facilitymedian $170 · 10th–90th $141–$2290%10%20%10th90th$170Professionalmedian $50 · 10th–90th $40–$710%10%20%10th90th$50$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $70.79
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $63.10 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $169.82 / $229.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $53.70 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $63.10 / $81.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $134.90 / $158.49
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $54.95 / $77.62