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Indiana 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
$42.40 / $52.52 / $66.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $49.46 / $63.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.96 / $87.96 / $87.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13.15 / $13.15 / $45.52
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$13.15 / $25.95 / $47.56
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.54 / $44.38 / $51.21
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.78 / $57.17 / $68.29
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.12 / $64.11 / $89.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.24 / $66.70 / $92.46