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Iowa 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
$54.41 / $54.41 / $70.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.52 / $50.21 / $63.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.92 / $116.20 / $145.82
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.39 / $66.41 / $128.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.06 / $77.12 / $222.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.56 / $97.14 / $309.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $97.14 / $124.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.92 / $97.61 / $126.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.87 / $74.23 / $136.71
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.10 / $69.59 / $90.40