go back

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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.86 / $47.86 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $69.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $66.07 / $102.33
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $77.62 / $107.15
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $158.49 / $162.18
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $63.10 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $85.11 / $131.83