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Maine 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.

Professionalmedian $54 · 10th–90th $42–$930%10%20%10th90th$54$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
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $70.79
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $70.79 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $72.44 / $104.71
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $69.18 / $125.89
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $53.70 / $75.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $83.18 / $107.15