go back

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.

Facilitymedian $58 · 10th–90th $47–$760%20%40%10th90th$58Professionalmedian $50 · 10th–90th $39–$650%20%10th90th$50$50.0$100.0$200.0

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 / $46.77 / $57.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$38.90 / $48.98 / $63.10
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $63.10
CareSource
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$56.23 / $56.23 / $56.23
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$75.86 / $75.86 / $75.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$46.77 / $69.18 / $295.12
Highmark BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $95.50 / $223.87
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$281.84 / $281.84 / $281.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $66.07 / $102.33