go back

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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $57.15 / $65.73
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.81 / $54.85 / $76.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.53 / $45.38 / $119.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.40 / $55.57 / $104.65
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $131.46 / $253.22
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.20 / $64.84 / $96.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.08 / $71.17 / $123.56
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.41 / $63.11 / $86.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.25 / $59.69 / $106.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.53 / $241.68 / $241.68
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.19 / $309.19 / $389.46
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $60.64 / $85.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.11 / $71.70 / $131.18
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.89 / $68.27 / $92.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.24 / $71.92 / $175.22