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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.60 / $63.49 / $63.49
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $51.60 / $63.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.46 / $53.46 / $62.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.87 / $73.20 / $73.20
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$69.54 / $76.13 / $98.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.23 / $65.76 / $119.01
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.60 / $62.37 / $63.49
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.95 / $57.98 / $70.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.66 / $67.28 / $94.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.74 / $72.83 / $90.17