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Kansas 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 $50 · 10th–90th $1–$650%20%10th90th$50Professionalmedian $50 · 10th–90th $38–$680%20%10th90th$50$0.1$0.5$2.0$10.0$50.0$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 / $56.23 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $50.12 / $64.57
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $63.10 / $63.10
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$0.76 / $0.95 / $1.02
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$0.06 / $0.09 / $0.09
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $75.86 / $95.50
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $66.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$64.57 / $93.33 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$69.18 / $181.97 / $190.55
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $69.18 / $95.50