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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.29 / $63.10 / $97.72
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $50.12 / $64.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $75.86 / $104.71
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $117.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.03 / $144.54 / $323.59
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $70.79 / $93.33
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.29 / $64.57 / $77.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $64.57 / $114.82
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $64.57 / $91.20