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Oregon 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 $102 · 10th–90th $49–$1260%20%10th90th$102Professionalmedian $59 · 10th–90th $43–$1260%20%10th90th$59$50.0$200.0$1.0K$5.0K$20.0K$100.0K$500.0K

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
$58.88 / $123.03 / $162.18
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $114.82 / $165.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $147.91
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $58.88 / $93.33
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $102.33 / $158.49
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $125.89
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $57.54 / $93.33
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $93.33 / $151.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$208.93 / $295.12 / $380.19
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$77.62 / $107.15 / $154.88
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $380.19 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$74.13 / $112.20 / $162.18