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New Jersey 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
$42.66 / $47.86 / $75.86
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $51.29 / $67.61
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $64.57 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $74.13 / $117.49
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$102.33 / $102.33 / $102.33
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $295.12 / $478.63
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $70.79 / $114.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $354.81 / $426.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $60.26 / $107.15