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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
$39.43 / $41.79 / $49.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.64 / $50.32 / $76.04
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$59.21 / $59.21 / $59.21
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.02 / $115.02 / $118.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.24 / $58.71 / $94.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.47 / $73.05 / $116.89
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.76 / $62.09 / $136.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.08 / $79.48 / $123.08