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Utah 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 $98 · 10th–90th $51–$1860%20%10th90th$98Professionalmedian $52 · 10th–90th $40–$740%10%20%10th90th$52$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
$51.29 / $63.10 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $51.29 / $70.79
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $77.62 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $117.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $181.97 / $275.42
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $66.07 / $93.33
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$51.29 / $64.57 / $77.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $64.57 / $102.33
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $66.07 / $91.20