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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
$39.64 / $49.29 / $74.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.64 / $49.14 / $64.27
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.39 / $59.39 / $72.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.06 / $40.42 / $53.26
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.89 / $52.50 / $65.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.89 / $57.19 / $81.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.46 / $62.73 / $123.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $67.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.67 / $69.34 / $100.82