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Nebraska 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 $93 · 10th–90th $46–$1550%10%10th90th$93Professionalmedian $58 · 10th–90th $43–$1170%10%20%10th90th$58$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
$57.54 / $93.33 / $141.25
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $57.54 / $93.33
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $120.23 / $158.49
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$64.57 / $64.57 / $64.57
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $125.89 / $245.47
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $83.18 / $117.49
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$93.33 / $117.49 / $147.91
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $58.88 / $109.65
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$75.86 / $120.23 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $117.49 / $154.88
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $117.49 / $144.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $134.90 / $173.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $151.36