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Texas 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 $65 · 10th–90th $42–$2040%5%10%10th90th$65Professionalmedian $50 · 10th–90th $39–$710%10%20%10th90th$50$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
$39.81 / $51.29 / $77.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $50.12 / $69.18
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $66.07 / $75.86
Ambetter
Facility/Professional
Professional
Modifier
25
Typical Low / Median / Typical High
$66.07 / $66.07 / $66.07
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$64.57 / $144.54 / $263.03
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $50.12 / $64.57
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$43.65 / $66.07 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $64.57 / $100.00
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $309.03 / $309.03
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $389.05
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $52.48 / $74.13
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $51.29 / $85.11
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $72.44
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $64.57 / $100.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $177.83 / $208.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $61.66 / $91.20
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $69.18 / $81.28