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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.

Facilitymedian $72 · 10th–90th $48–$1290%10%10th90th$72Professionalmedian $60 · 10th–90th $43–$1070%10%10th90th$60$50.0$100.0$200.0$500.0$1.0K

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
$56.23 / $104.71 / $138.04
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$40.74 / $53.70 / $85.11
Ambetter
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $97.72
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$186.21 / $239.88 / $478.63
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $89.13 / $134.90
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $97.72 / $154.88
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $67.61 / $120.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $63.10 / $107.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $67.61
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$74.13 / $125.89 / $125.89
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $83.18 / $91.20
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $93.33 / $151.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $245.47 / $478.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $85.11 / $128.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$288.40 / $380.19 / $691.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$67.61 / $91.20 / $147.91
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $69.18 / $97.72