CPT code 99424: Principal care management, physician/QHP, first 30 minutes2026 Medicare rate & RVUs in Vermont

In Vermont, Medicare pays $85.34 for 99424 in the office and $62.86 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99424 nationwide

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

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.

How Vermont compares for 99424

Across 109 of 109 payment localities, the office rate for 99424 runs from $80.74 in Arkansas to $112.38 in Alaska. Vermont pays $85.34. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99424 rates by state

Office rate range in each state. Select a state to see its payment localities.

See 99424 in every payment locality

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.

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.

Codes related to 99424

Related codes aren’t interchangeable: bill the code that matches the service performed.

How 99424 has changed in Vermont

Price 99424 for an earlier date of service

Where the Vermont rate applies

Vermont is a Medicare payment area, not a city. Our Census mapping connects it to 180 cities and communities in Vermont. Some span more than one payment area; confirm with the service ZIP.

• Albany
• Alburgh
• Algiers
• Arlington
• Ascutney
• Bakersfield
• Barnet
• Barre

Browse all communities in Vermont

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

Open CMS sourceHow we calculate rates