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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.77 / $48.35 / $184.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.77 / $49.10 / $63.49
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.49 / $50.49 / $50.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.65 / $54.85 / $84.33
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.82 / $43.53 / $62.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.02 / $61.00 / $102.05
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.04 / $62.37 / $100.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.98 / $71.16 / $101.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.81 / $74.73 / $112.08