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South Dakota 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
$48.50 / $48.50 / $61.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $50.21 / $71.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.85 / $118.10 / $145.26
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.72 / $58.34 / $103.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.33 / $115.60 / $389.46
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $97.10 / $121.05
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.92 / $97.14 / $121.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.76 / $80.84 / $122.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.81 / $111.90 / $125.23
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.10 / $71.70 / $93.10