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Virginia 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 $60 · 10th–90th $44–$910%10%20%10th90th$60Professionalmedian $52 · 10th–90th $40–$760%10%20%10th90th$52$10.0$50.0$200.0$1.0K$5.0K

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 / $60.26 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $48.98 / $63.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $64.57 / $89.13
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $53.70 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $69.18 / $102.33
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $60.26 / $89.13
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $54.95 / $75.86
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $64.57 / $10,000.00
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$57.54 / $81.28 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $199.53 / $630.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $69.18 / $117.49