go back

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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.77 / $60.26 / $72.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $50.12 / $64.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $64.57 / $89.13
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $51.29 / $66.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $69.18 / $104.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.02 / $57.54 / $89.13
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $53.70 / $75.86
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $64.57 / $7,413.10
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.88 / $81.28 / $7,413.10
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.83 / $199.53 / $630.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $70.79 / $117.49