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Ohio 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 $52 · 10th–90th $39–$1580%20%10th90th$52Professionalmedian $51 · 10th–90th $39–$760%10%20%10th90th$51$1.0$5.0$20.0$100.0$500.0

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 / $52.48 / $158.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $48.98 / $64.57
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $64.57 / $97.72
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $61.66 / $97.72
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $46.77 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $104.71
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $64.57 / $102.33
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$125.89 / $125.89 / $125.89
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $67.61 / $125.89
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$204.17 / $245.47 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $66.07 / $102.33