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Georgia 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
$38.90 / $40.74 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $75.86
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$58.88 / $58.88 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $74.13 / $114.82
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $54.95 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $75.86 / $123.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $69.18 / $138.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $69.18 / $117.49