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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.12 / $64.57 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $67.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $162.18 / $309.03
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $74.13 / $165.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $58.88 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $63.10 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $89.13 / $141.25
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.70 / $70.79 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.66 / $75.86 / $120.23
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $81.28 / $141.25
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.95 / $162.18 / $309.03
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $75.86 / $165.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.79 / $223.87 / $380.19
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $81.28 / $165.96