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Wisconsin 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 $59 · 10th–90th $46–$1620%10%20%10th90th$59Professionalmedian $60 · 10th–90th $43–$1350%10%10th90th$60$10.0$20.0$50.0$100.0$200.0$500.0

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 / $91.20 / $117.49
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$39.81 / $52.48 / $85.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $77.62 / $147.91
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $190.55 / $309.03
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$70.79 / $134.90 / $177.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $58.88 / $83.18
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $114.82 / $173.78
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$45.71 / $58.88 / $91.20
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $128.82 / $389.05
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $64.57 / $131.83
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $97.72 / $173.78
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $93.33 / $309.03
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $131.83 / $389.05
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $74.13
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $100.00 / $128.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $269.15 / $354.81
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $95.50 / $162.18