Emergency · 99426
Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month
What Medicare pays for 99426, what providers bill, and how the price varies across 48 states, drawn from CMS 2023 claims data.
- $46.61
- Medicare pays
- $144.96
- Providers bill
- 3.1×
- Markup
- #824 of 9,297
- Volume rank
The verdict
Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month pairs top-10% national service volume with one of the smaller markups in the catalog.
- Top 9%
- national service volume
- 18th pct.
- billed-to-Medicare markup
- 3.1×
- billed vs. Medicare
- $46.61
- Medicare pays, national avg
Volume percentile ranks this code's national service volume against every tracked procedure; markup percentile ranks its billed-to-Medicare ratio the same way. The same two figures drive both the verdict sentence and the chips above.
According to the Centers for Medicare & Medicaid Services (CMS), the 2023 Medicare Physician & Other Practitioners dataset records payments for 9,297 procedure codes billed across 5,426 hospitals in 56 states and territories; see our methodology for how each figure is sourced and computed.
Jurisdiction coverage for this code
56states and territories in the CMS extract
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024). We map each PlainProcedure category onto a RAND CPT-section bucket (Surgery, Radiology, Pathology and Laboratory, Medicine, Anesthesia, Evaluation and Management) or fall back to the national average when no bucket matches. For Emergency, the applied ratio is 2.15x Medicare (RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline). Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
3 more affordable than 18% of 8,901 procedures
Each bar is a 1-wide band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
What the billed charge breaks down into
$144.96
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| California | $50.95 | $151.68 |
| New Jersey | $50.64 | $172.77 |
| Maryland | $50.39 | $108.83 |
| Hawaii | $49.60 | $87.73 |
| New York | $49.57 | $163.72 |
| District of Columbia | $48.85 | $132.80 |
| Florida | $47.91 | $174.39 |
| Connecticut | $47.71 | $173.39 |
| Alaska | $47.65 | $306.00 |
| North Dakota | $47.63 | $59.87 |
| Colorado | $47.42 | $143.65 |
| Delaware | $47.28 | $93.86 |
| Rhode Island | $47.24 | $178.47 |
| Massachusetts | $46.71 | $140.88 |
| Montana | $46.65 | $130.02 |
| Illinois | $46.51 | $123.83 |
| Virginia | $46.38 | $128.14 |
| Puerto Rico | $46.16 | $117.63 |
| Michigan | $45.99 | $122.32 |
| Wyoming | $45.89 | $219.58 |
| Pennsylvania | $45.81 | $201.57 |
| Arizona | $45.57 | $147.61 |
| Kansas | $45.54 | $113.18 |
| North Carolina | $45.38 | $137.07 |
| Texas | $45.33 | $127.29 |
| Alabama | $45.09 | $82.32 |
| Ohio | $44.82 | $178.05 |
| Utah | $44.64 | $175.40 |
| Nebraska | $44.59 | $120.39 |
| Kentucky | $44.55 | $88.40 |
| Washington | $44.51 | $174.97 |
| Minnesota | $44.49 | $167.05 |
| Louisiana | $44.44 | $134.69 |
| Oklahoma | $43.95 | $131.98 |
| Tennessee | $43.93 | $133.18 |
| Wisconsin | $43.90 | $181.07 |
| Indiana | $43.69 | $184.12 |
| New Mexico | $43.60 | $148.10 |
| South Carolina | $43.48 | $78.70 |
| Iowa | $43.25 | $182.83 |
| Missouri | $43.20 | $132.17 |
| Idaho | $42.94 | $143.37 |
| Nevada | $42.80 | $180.00 |
| Georgia | $41.83 | $175.19 |
| Mississippi | $41.39 | $108.52 |
| Arkansas | $40.83 | $146.23 |
| West Virginia | $38.49 | $101.36 |
| Oregon | $37.01 | $152.31 |
What the Data Says About Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month
Across 48 states with reporting providers, CPT code 99426 (Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month) shows a national average Medicare payment of $46.61 against an average billed charge of $144.96. That gap, a 3.1x markup, or 211% above the Medicare allowed amount, is among the tightest billed-to-paid spreads we track, this code's chargemaster rate tracks unusually close to the Medicare benchmark.
Emergency procedures like this one saw 222.3K services billed to Medicare in 2023 by 3.3K distinct providers, serving 58.8K unique beneficiaries. State-level variation is significant: Oregon reports the lowest average payment at $37.01, while California reports the highest at $50.95. The 38% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it. Applying the RAND 2024 commercial-to-Medicare ratio for this category (2.15x Medicare; RAND 2024 Medicine bucket (2.15x) + CMS Medicare baseline), the estimated commercial insurance price lands near $128.67, with self-pay cash discounts commonly bringing the figure closer to $84.75. Within Emergency, Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month ranks #21 of 35 tracked procedures by national average Medicare payment.
Where this sits in the registry
Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month (99426) is a CMS 2023 Part B code. These pages keep the volume map and the markup map separate.
- National volume versus markup on the statistics page, the same two maps as this capsule. Statistics
- Other Emergency codes, ranked by Medicare payment inside the category. Category
- How volume rank and markup rank are computed. Methodology
- The full procedures listing in volume order. Procedures
Figures here are CMS averages, not a quote for any patient, plan, or visit.
Frequently Asked Questions
Where does Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month rank among Medicare procedures?
According to CMS Medicare Part B claims, Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month (CPT 99426) ranks #824 of 9,297 procedures by national service volume, the same sort as the procedures listing, and #21 of 35 within Emergency by national average Medicare payment. See /methodology#corpus-placement.
How much does Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month cost?
Medicare's national average payment for Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month (CPT 99426) is $46.61, with providers billing $144.96 on average; state rates run from $37.01 to $50.95, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month cost with insurance?
With commercial insurance, principal care management services for a single high-risk disease, first 30 minutes of clinical staff time directed by health care professional, per calendar month costs an estimated $128.67 on average (range: $90.07-$180.14), a moderate premium over Medicare's $46.61. Without insurance, the estimated cash price is $84.75.
Which state has the lowest cost for Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month?
Oregon has the lowest average Medicare payment for Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month at $37.01, while California has the highest at $50.95 - a meaningful $13.94 spread.
How many providers perform Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month?
A moderate provider base performs Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month: 3.3K providers nationally, totaling 222.3K Medicare-billed services (58.8K beneficiaries) across 48 states in 2023.
What is the billed-to-Medicare markup for Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month?
Providers bill 3.1x what Medicare pays for Principal Care Management Services For A Single High-Risk Disease, First 30 Minutes Of Clinical Staff Time Directed By Health Care Professional, Per Calendar Month - one of the smaller markups in the catalog at 211% above the Medicare rate.
Nationwide similar CPT codes
Data-derived peers across the CMS Physician & Other Practitioners extract: nearest national service volume and nearest average Medicare payment. Not clinical substitutes: claim-mass and payment neighborhoods only.
Closest national service volume
Nearest codes with ≥100 services (222.3K here).
Closest average Medicare payment
Nearest codes with payment ≥ $5 ($46.61 here).
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, the data changelog, or report a data error.