CPT code 99424: Principal care management, physician/QHP, first 30 minutes2026 Medicare rate & RVUs in Texas
Reports the first 30 minutes of monthly physician or qualified health professional care management for one complex, high-risk chronic condition.
Medicare pays $84.06–$89.24 for 99424 in the office in Texas, from Beaumont, TX to Austin, TX. Which amount applies depends on the service address.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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What 99424 covers
A physician or other qualified health care professional reports this monthly service for management of one complex chronic condition expected to last at least three months and placing the patient at significant risk of hospitalization, functional decline, or another serious outcome. The work centers on a disease-specific care plan and ongoing management, such as coordinating input among treating clinicians or adjusting the plan as the condition changes. It may be furnished in an office or other setting where the practitioner manages the patient’s care.
Report 99424 once for a calendar month when the physician or qualified health care professional personally provides at least 30 minutes of qualifying principal care management work. The record should identify the condition, its risk and management needs, the care plan, and the practitioner’s time and activities. This is not the staff-time code: clinical staff time is represented by 99426 and 99427. CMS fee-schedule valuation includes physician work, practice expense, and malpractice components.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 99424 pays more and less in Texas
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
8 payment localities
$84.06 to $89.24
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin, TX | $89.24 | $65.21 |
| Beaumont, TX | $84.06 | $63.39 |
| Brazoria, TX | $86.77 | $64.26 |
| Dallas, TX | $87.28 | $64.66 |
| Fort Worth, TX | $86.98 | $64.58 |
| Galveston, TX | $87.02 | $64.46 |
| Houston, TX | $89.03 | $66.48 |
| Rest of Texas | $85.35 | $63.79 |
How the 99424 rate is calculated
Each of 99424’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 99424
RVUs × geographic indexes × conversion factor
Work1.45
1.45 RVUs× 1.000 GPCI
Practice expense1.06
1.06 RVUs× 1.000 GPCI
Malpractice0.11
0.11 RVUs× 1.000 GPCI
Adjusted RVUs
2.6200
Conversion factor
$33.4009
Medicare rate
$87.51
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for 99424
99424 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · 99424
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
$87.51
- Non-facility (office)
- $87.51
- Facility
- $64.80
Higher because the practice carries its own overhead.
99424 compared with similar codes
Compare codes · National
4 codes, side by side
How to choose
- 99425Principal care managementEach additional 30 minutes
- 99424 covers the first 30 minutes of physician or qualified health professional principal care management in the month; 99425 covers each additional 30 minutes.
- 99426Principal care managementClinical staff, initial 30 minutes
- 99426 is the staff-time counterpart for the first 30 minutes. Use 99424 for qualifying time personally furnished by the physician or qualified health professional.
- 99491Chronic care management30 minutes, physician/QHP time
- 99491 is physician or qualified health professional chronic care management. 99424 is focused on one complex, high-risk chronic condition and its principal care plan.
99424 billing questions
What distinguishes principal care management from chronic care management?
Principal care management centers on one complex, high-risk chronic condition. Chronic care management codes such as 99491 address a different care-management service and eligibility framework.
Does 99424 include clinical staff time?
No. It represents qualifying time personally furnished by a physician or other qualified health care professional. Staff time is addressed by 99426 and 99427.
How much time supports 99424?
At least 30 minutes of qualifying physician or qualified health care professional time in the calendar month. Document the time and the principal care management work performed.
Can the code be billed once for each call or care coordination contact?
No. It is a monthly service, not a per-contact code. The documented qualifying work must reach the 30-minute threshold during the calendar month.
When is 99425 reported with 99424?
99425 is the add-on code for each additional 30 minutes of physician or qualified health care professional principal care management in the same calendar month.
What documentation supports choosing 99424?
Document the single complex chronic condition, why it presents significant risk, the disease-specific care plan and management activities, and the physician or qualified health care professional’s time.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
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