go back

Michigan 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 $63 · 10th–90th $51–$1780%20%10th90th$63Professionalmedian $52 · 10th–90th $41–$710%10%20%10th90th$52$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
$51.29 / $63.10 / $63.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $67.61
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $79.43 / $97.72
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $72.44 / $77.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $69.18 / $123.03
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $154.88 / $181.97
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $56.23 / $83.18
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $66.07 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$104.71 / $169.82 / $323.59
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $66.07 / $87.10