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Washington 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
$56.23 / $104.71 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.74 / $53.70 / $85.11
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.23 / $64.57 / $97.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $93.33 / $147.91
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$44.67 / $64.57 / $114.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $63.10 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $67.61
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $120.23 / $125.89
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.18 / $83.18 / $91.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $109.65 / $158.49
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $251.19 / $478.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.61 / $89.13 / $128.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $380.19 / $691.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.57 / $91.20 / $158.49
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $69.18 / $97.72