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Nevada 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 $47 · 10th–90th $39–$490%20%40%10th90th$47Professionalmedian $51 · 10th–90th $40–$690%10%20%10th90th$51$10.0$20.0$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
$38.90 / $38.90 / $48.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $67.61
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $93.33
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $66.07 / $95.50
Hometown Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $67.61 / $95.50
Hometown Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $102.33 / $102.33
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $74.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $67.61 / $107.15