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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.32 / $67.93 / $111.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $51.60 / $75.42
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.40 / $66.40 / $66.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.89 / $57.69 / $96.80
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$70.56 / $70.56 / $70.56
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.56 / $70.56 / $88.08
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.84 / $73.39 / $152.09
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.30 / $62.12 / $332.00
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.15 / $100.56 / $150.84
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.42 / $59.86 / $59.86
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $68.84 / $106.79
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $74,999.25
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.50 / $77.54 / $152.65
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.02 / $72.93 / $146.55
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.56 / $59.86 / $71.84
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.90 / $70.04 / $120.89