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Kentucky 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
$43.65 / $67.61 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $67.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $66.07 / $120.23
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $38.90 / $52.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.90 / $52.48 / $72.44
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $54.95 / $75.86
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $70.79 / $295.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $38.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $63.10 / $93.33