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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.

Facilitymedian $56 · 10th–90th $46–$810%20%10th90th$56Professionalmedian $55 · 10th–90th $39–$1170%10%20%10th90th$55$50.0$100.0$200.0

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
$47.86 / $47.86 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.02 / $48.98 / $63.10
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $120.23 / $147.91
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $56.23 / $102.33
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $114.82 / $389.05
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $97.72 / $120.23
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $79.43 / $123.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $97.72 / $141.25
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $72.44 / $93.33