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Florida 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 $58 · 10th–90th $39–$1050%10%10th90th$58Professionalmedian $51 · 10th–90th $40–$710%10%20%10th90th$51$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
$38.90 / $52.48 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $69.18
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $66.07 / $79.43
AvMed
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $56.23 / $70.79
AvMed
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $56.23 / $72.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $102.33
Florida Blue
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $50.12 / $63.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $72.44
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$117.49 / $123.03 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $60.26 / $102.33
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $52.48 / $67.61