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Tennessee 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 $58–$3090%20%10th90th$102Professionalmedian $50 · 10th–90th $40–$680%20%10th90th$50$10.0$20.0$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
$46.77 / $81.28 / $102.33
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $48.98 / $63.10
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $63.10 / $91.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $61.66 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $104.71
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $309.03 / $309.03
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$181.97 / $181.97 / $181.97
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $64.57 / $104.71