go back

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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.35 / $51.35 / $63.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.43 / $51.28 / $67.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.26 / $76.29 / $98.26
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.51 / $58.17 / $68.44
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$124.00 / $171.56 / $246.30
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.17 / $70.97 / $90.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.07 / $69.76 / $100.65