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Arizona 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.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $69.18
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $63.10 / $75.86
Ambetter
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$66.07 / $66.07 / $66.07
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11.22 / $33.11 / $53.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $46.77 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $64.57 / $102.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.02 / $51.29 / $100.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $87.10 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $67.61 / $93.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $63.10 / $104.71