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West 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
$47.73 / $47.73 / $58.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.77 / $49.13 / $61.66
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.50 / $44.89 / $83.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.64 / $55.64 / $55.64
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 / $62.73 / $229.19
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.97 / $95.97 / $223.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.31 / $93.81 / $146.26