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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.

Facilitymedian $85 · 10th–90th $42–$4170%10%10th90th$85Professionalmedian $50 · 10th–90th $38–$710%10%10th90th$50$10.0$20.0$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
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $58.88 / $89.13
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $67.61
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $75.86 / $95.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$13.18 / $309.03 / $416.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$13.18 / $25.70 / $54.95
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $45.71 / $50.12
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $42.66 / $42.66
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $63.10 / $85.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $61.66 / $89.13