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Montana 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 $85 · 10th–90th $49–$1070%20%10th90th$85Professionalmedian $55 · 10th–90th $40–$850%10%20%10th90th$55$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
$39.81 / $53.70 / $75.86
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $69.18 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $97.72 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $77.62 / $123.03
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $91.20 / $109.65
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$83.18 / $91.20 / $109.65
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $56.23 / $89.13
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $112.20
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $93.33 / $120.23