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California 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 $50 · 10th–90th $39–$1230%10%20%10th90th$50Professionalmedian $56 · 10th–90th $42–$1020%10%10th90th$56$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $67.61 / $181.97
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $89.13
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $63.10 / $85.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$38.90 / $48.98 / $123.03
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $61.66 / $131.83
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $177.83 / $288.40
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $67.61 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $120.23
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $56.23 / $95.50
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $56.23 / $95.50
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $57.54 / $89.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $72.44 / $123.03
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $70.79 / $93.33
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $194.98 / $257.04
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $66.07 / $141.25