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Minnesota 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 $186 · 10th–90th $51–$4470%5%10th90th$186Professionalmedian $83 · 10th–90th $47–$1620%5%10%10th90th$83$50.0$100.0$200.0$500.0

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
$47.86 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $64.57
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $218.78 / $660.69
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $112.20 / $177.83
BCBS
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$56.23 / $87.10 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$158.49 / $229.09 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $162.18 / $275.42
Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $229.09 / $446.68
Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $162.18 / $223.87
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$46.77 / $69.18 / $131.83
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $138.04 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $263.03 / $363.08
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $123.03 / $199.53