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Idaho 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 $63 · 10th–90th $44–$2000%10%10th90th$63Professionalmedian $54 · 10th–90th $40–$930%10%20%10th90th$54$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
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $52.48 / $81.28
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$147.91 / $199.53 / $281.84
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $97.72 / $125.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $83.18 / $117.49
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $57.54 / $89.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $77.62 / $123.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $199.53 / $281.84
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $79.43 / $100.00
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $64.57 / $151.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $72.44 / $107.15