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Colorado 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 $63 · 10th–90th $48–$630%20%40%10th$63Professionalmedian $51 · 10th–90th $40–$810%10%20%10th90th$51$10.0$20.0$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
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $74.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $64.57 / $100.00
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $77.62 / $104.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $158.49 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $63.10 / $69.18
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $95.50
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $85.11 / $125.89