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Pennsylvania 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 $105 · 10th–90th $42–$4070%10%10th90th$105Professionalmedian $51 · 10th–90th $40–$680%20%10th90th$51$1.0$10.0$100.0$1.0K$10.0K

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
$41.69 / $104.71 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $66.07
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $66.07 / $104.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $69.18 / $100.00
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $61.66 / $112.20
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $52.48
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $70.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1.00 / $54.95 / $61.66
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$11.75 / $54.95 / $67.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $302.00 / $346.74
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $67.61 / $104.71