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Massachusetts 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 $65 · 10th–90th $50–$1320%20%10th90th$65Professionalmedian $55 · 10th–90th $42–$1200%20%10th90th$55$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$50.12 / $64.57 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $67.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $162.18 / $309.03
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $75.86 / $169.82
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $67.61 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $63.10 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $91.20 / $144.54
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.18 / $64.57 / $120.23
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $75.86 / $114.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $81.28 / $141.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $162.18 / $309.03
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $75.86 / $169.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $186.21 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $81.28 / $177.83