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New York 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 $71 · 10th–90th $48–$1290%20%10th90th$71Professionalmedian $54 · 10th–90th $40–$980%20%10th90th$54$20.0$100.0$500.0$2.0K$10.0K$50.0K

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
$52.48 / $72.44 / $128.82
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $83.18
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $63.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $58.88 / $109.65
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $70.79
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $70.79 / $87.10
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $77.62 / $169.82
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$29.51 / $51.29 / $123.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $102.33 / $151.36
Excellus BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $60.26 / $60.26
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $69.18 / $112.20
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50,118.72 / $53,703.18 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $85.11 / $97.72
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $239.88 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $67.61 / $141.25
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$40.74 / $47.86 / $72.44
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $70.79 / $114.82