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Maryland 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 $68 · 10th–90th $51–$930%10%20%10th90th$68Professionalmedian $50 · 10th–90th $40–$660%10%20%10th90th$50$50.0$100.0$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
$57.54 / $57.54 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $48.98 / $63.10
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $51.29 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $69.18 / $114.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$35.48 / $56.23 / $81.28
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $67.61 / $93.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $104.71
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $93.33 / $109.65