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North Carolina 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 $56 · 10th–90th $43–$850%10%20%10th90th$56Professionalmedian $54 · 10th–90th $40–$810%10%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
Facility
Modifier
Typical Low / Median / Typical High
$48.98 / $60.26 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $51.29 / $67.61
Aetna
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$58.88 / $58.88 / $58.88
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $63.10 / $64.57
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.88 / $53.70 / $81.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $74.13 / $123.03
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $72.44
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $69.18 / $109.65
Wellcare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Wellcare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05