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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.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.17 / $60.51 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.34 / $49.46 / $62.86
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.86 / $57.38 / $79.09
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.39 / $51.39 / $71.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.88 / $65.88 / $65.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.10 / $69.19 / $106.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $60.92 / $82.38
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.17 / $54.09 / $79.81
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.84 / $104.27 / $115.54
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.66 / $61.33 / $212.74
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.26 / $76.89 / $266.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.90 / $80.39 / $124.99