CPT code 99425: Principal care management, each additional 30 minutes2026 Medicare rate & RVUs in Puerto Rico
Reports each additional 30 minutes of physician or qualified professional time managing a single high-risk chronic condition during a calendar month.
In Puerto Rico, Medicare pays $61.71 for 99425 in the office and $44.15 when it’s performed in a hospital or facility.
Check a contract rate as a % of Medicare · 99425 nationwide
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 11 sections
What 99425 covers
Code 99425 captures each additional 30 minutes a physician or other qualified health care professional spends managing a patient’s single complex, high-risk chronic condition during a calendar month. The condition is expected to last at least three months and places the patient at risk of hospitalization, exacerbation, or functional decline. Work may include carrying out or revising a condition-specific care plan and coordinating with specialists, the patient, or caregivers. Heart failure and COPD are common examples of conditions that may require this focused management.
Report 99425 with 99424, the initial physician or qualified professional principal care management time code, after documenting the additional time and the condition-focused management performed. Keep records of the care plan, coordination, and cumulative monthly time to support the service. CMS classifies 99425 as an add-on code: it must be billed with a primary procedure and is paid within that procedure’s global period.
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 Puerto Rico compares for 99425
Across 109 of 109 payment localities, the office rate for 99425 runs from $56.70 in Arkansas to $78.78 in Alaska. Puerto Rico pays $61.71. The RVUs are the same everywhere; the geographic indexes change the dollars.
- Puerto Rico · this page$61.71
- Los Angeles, CA · California$66.75+$5.04
- Washington, DC area · District of Columbia$68.10+$6.39
- Miami, FL · Florida$66.09+$4.38
- Chicago, IL · Illinois$64.85+$3.14
- Manhattan, NY · New York$69.13+$7.42
- Alaska · Alaska$78.78+$17.07
Other areas in Puerto Rico first, then benchmark localities. Bars start at $0.
Every other payment area
| Payment locality | Office | Facility |
|---|---|---|
| AlabamaAlabama | $57.23 | $42.03 |
| ArkansasArkansas | $56.70 | $41.78 |
| ArizonaArizona | $60.32 | $43.49 |
| Bakersfield, CACalifornia | $63.65 | $44.61 |
| Chico, CACalifornia | $63.41 | $44.37 |
| El Centro, CACalifornia | $63.42 | $44.39 |
| Fresno, CACalifornia | $63.41 | $44.37 |
| Hanford, CACalifornia | $63.41 | $44.37 |
| Madera, CACalifornia | $63.41 | $44.37 |
| Merced, CACalifornia | $63.41 | $44.37 |
| Modesto, CACalifornia | $63.41 | $44.37 |
| Napa, CACalifornia | $70.59 | $47.70 |
| Oxnard, CACalifornia | $66.19 | $45.66 |
| Redding, CACalifornia | $63.41 | $44.37 |
| Rest of CaliforniaCalifornia | $63.41 | $44.37 |
| Riverside, CACalifornia | $64.18 | $45.15 |
| Sacramento, CACalifornia | $65.77 | $45.57 |
| Salinas, CACalifornia | $65.50 | $45.37 |
| San Diego, CACalifornia | $66.43 | $45.66 |
| Marin County, CACalifornia | $73.91 | $49.42 |
| San Francisco, CACalifornia | $73.83 | $49.34 |
| San Benito County, CACalifornia | $75.41 | $50.37 |
| Santa Clara County, CACalifornia | $75.09 | $50.04 |
| San Luis Obispo, CACalifornia | $64.52 | $44.73 |
| Santa Cruz, CACalifornia | $66.60 | $45.50 |
| Santa Maria, CACalifornia | $65.58 | $45.33 |
| Santa Rosa, CACalifornia | $67.24 | $45.91 |
| Stockton, CACalifornia | $63.41 | $44.37 |
| Vallejo, CACalifornia | $70.48 | $47.58 |
| Visalia, CACalifornia | $63.41 | $44.37 |
| Yuba City, CACalifornia | $63.41 | $44.37 |
| ColoradoColorado | $62.99 | $44.51 |
| ConnecticutConnecticut | $64.60 | $45.89 |
| DelawareDelaware | $61.08 | $43.92 |
| Fort Lauderdale, FLFlorida | $63.68 | $46.09 |
| Rest of FloridaFlorida | $61.50 | $44.90 |
| Atlanta, GAGeorgia | $62.44 | $44.79 |
| Rest of GeorgiaGeorgia | $59.13 | $43.64 |
| Hawaii, Guam, HIHawaii | $64.00 | $44.25 |
| IowaIowa | $57.86 | $41.97 |
| IdahoIdaho | $58.17 | $42.19 |
| East St. Louis, ILIllinois | $61.77 | $45.79 |
| Rest of IllinoisIllinois | $60.54 | $44.68 |
| Suburban Chicago, ILIllinois | $64.19 | $46.35 |
| IndianaIndiana | $58.38 | $42.28 |
| KansasKansas | $57.83 | $42.13 |
| KentuckyKentucky | $58.40 | $42.96 |
| New Orleans, LALouisiana | $60.26 | $43.91 |
| Rest of LouisianaLouisiana | $58.40 | $43.03 |
| Metropolitan Boston, MAMassachusetts | $67.56 | $46.82 |
| Rest of MassachusettsMassachusetts | $62.88 | $44.59 |
| Baltimore area, MDMaryland | $64.42 | $45.79 |
| Rest of MarylandMaryland | $61.91 | $44.33 |
| Rest of MaineMaine | $58.52 | $42.54 |
| Southern Maine, MEMaine | $60.36 | $43.15 |
| Detroit, MIMichigan | $62.16 | $45.40 |
| Rest of MichiganMichigan | $59.52 | $43.66 |
| MinnesotaMinnesota | $60.56 | $42.69 |
| Metropolitan Kansas City, MOMissouri | $59.84 | $43.53 |
| Metropolitan St. Louis, MOMissouri | $60.23 | $43.69 |
| Rest of MissouriMissouri | $57.85 | $42.88 |
| MississippiMississippi | $57.27 | $42.32 |
| MontanaMontana | $61.45 | $44.08 |
| North CarolinaNorth Carolina | $58.89 | $42.69 |
| North DakotaNorth Dakota | $60.07 | $42.70 |
| NebraskaNebraska | $58.02 | $41.99 |
| New HampshireNew Hampshire | $62.22 | $44.14 |
| Northern New JerseyNew Jersey | $67.84 | $47.69 |
| Rest of New JerseyNew Jersey | $65.39 | $46.42 |
| New MexicoNew Mexico | $59.79 | $43.87 |
| NevadaNevada | $61.09 | $43.71 |
| NYC suburbs and Long Island, NYNew York | $70.46 | $49.81 |
| Poughkeepsie and northern NYC suburbs, NYNew York | $65.89 | $46.88 |
| Queens, NYNew York | $69.31 | $48.78 |
| Rest of New YorkNew York | $59.48 | $42.98 |
| OhioOhio | $59.24 | $43.38 |
| OklahomaOklahoma | $58.18 | $42.67 |
| Portland, OROregon | $64.25 | $44.95 |
| Rest of OregonOregon | $60.66 | $43.36 |
| Metropolitan Philadelphia, PAPennsylvania | $63.56 | $45.48 |
| Rest of PennsylvaniaPennsylvania | $59.22 | $43.28 |
| Rhode IslandRhode Island | $62.69 | $44.75 |
| South CarolinaSouth Carolina | $59.15 | $43.10 |
| South DakotaSouth Dakota | $59.91 | $42.54 |
| TennesseeTennessee | $58.03 | $42.25 |
| Austin, TXTexas | $62.75 | $44.37 |
| Beaumont, TXTexas | $58.98 | $43.17 |
| Brazoria, TXTexas | $60.98 | $43.77 |
| Dallas, TXTexas | $61.32 | $44.02 |
| Fort Worth, TXTexas | $61.10 | $43.97 |
| Galveston, TXTexas | $61.14 | $43.90 |
| Houston, TXTexas | $62.42 | $45.18 |
| Rest of TexasTexas | $59.92 | $43.44 |
| UtahUtah | $59.68 | $43.35 |
| VirginiaVirginia | $60.33 | $43.26 |
| Virgin Islands, VIUnited States Virgin Islands | $61.71 | $44.15 |
| VermontVermont | $60.05 | $42.85 |
| Rest of WashingtonWashington | $62.70 | $44.41 |
| King County, WAWashington | $68.54 | $47.23 |
| WisconsinWisconsin | $58.76 | $42.12 |
| West VirginiaWest Virginia | $59.10 | $44.00 |
| WyomingWyoming | $60.85 | $43.48 |
99425 rates by state
Office rate range in each state. Select a state to see its payment localities.
Explore a state
Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$56.70
$78.78
Color shows the midpoint of each state’s locality range.
View every state and territory as a table
| State / territory | Office rate range | Localities |
|---|---|---|
| AK | $78.78 | 1 |
| AL | $57.23 | 1 |
| AR | $56.70 | 1 |
| AZ | $60.32 | 1 |
| CA | $63.41–$75.41 | 29 |
| CO | $62.99 | 1 |
| CT | $64.60 | 1 |
| DC | $68.10 | 1 |
| DE | $61.08 | 1 |
| FL | $61.50–$66.09 | 3 |
| GA | $59.13–$62.44 | 2 |
| GU | $64.00 | 1 |
| HI | $64.00 | 1 |
| IA | $57.86 | 1 |
| ID | $58.17 | 1 |
| IL | $60.54–$64.85 | 4 |
| IN | $58.38 | 1 |
| KS | $57.83 | 1 |
| KY | $58.40 | 1 |
| LA | $58.40–$60.26 | 2 |
| MA | $62.88–$67.56 | 2 |
| MD | $61.91–$68.10 | 3 |
| ME | $58.52–$60.36 | 2 |
| MI | $59.52–$62.16 | 2 |
| MN | $60.56 | 1 |
| MO | $57.85–$60.23 | 3 |
| MS | $57.27 | 1 |
| MT | $61.45 | 1 |
| NC | $58.89 | 1 |
| ND | $60.07 | 1 |
| NE | $58.02 | 1 |
| NH | $62.22 | 1 |
| NJ | $65.39–$67.84 | 2 |
| NM | $59.79 | 1 |
| NV | $61.09 | 1 |
| NY | $59.48–$70.46 | 5 |
| OH | $59.24 | 1 |
| OK | $58.18 | 1 |
| OR | $60.66–$64.25 | 2 |
| PA | $59.22–$63.56 | 2 |
| PR | $61.71 | 1 |
| RI | $62.69 | 1 |
| SC | $59.15 | 1 |
| SD | $59.91 | 1 |
| TN | $58.03 | 1 |
| TX | $58.98–$62.75 | 8 |
| UT | $59.68 | 1 |
| VA | $60.33–$68.10 | 2 |
| VI | $61.71 | 1 |
| VT | $60.05 | 1 |
| WA | $62.70–$68.54 | 2 |
| WI | $58.76 | 1 |
| WV | $59.10 | 1 |
| WY | $60.85 | 1 |
How the 99425 rate is calculated
Each of 99425’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 · 99425
RVUs × geographic indexes × conversion factor
Work1.00
1.00 RVUs× 1.000 GPCI
Practice expense0.77
0.77 RVUs× 1.000 GPCI
Malpractice0.07
0.07 RVUs× 1.000 GPCI
Adjusted RVUs
1.8400
Conversion factor
$33.4009
Medicare rate
$61.46
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
The exact Puerto Rico inputs and CMS source lines
PPRRVU2026_Oct_nonQPP.csv
13,106
- Code
- 99425
- Physician work
- 1.00
- Practice expense
- 0.77
- Malpractice
- 0.07
GPCI2026.csv
91
- Locality
- Puerto Rico
- Physician work
- 1.000
- Practice expense
- 1.011
- Malpractice
- 0.985
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.00 | × 1.000 | 1.0000 |
| Practice expense | 0.77 | × 1.011 | 0.7785 |
| Malpractice | 0.07 | × 0.985 | 0.0690 |
| Total RVUs | 1.8474 | ||
| Conversion factor | × 33.4009 | ||
Office rate, Puerto Rico$61.71
Office: (1 × 1 + 0.77 × 1.011 + 0.07 × 0.985) × $33.4009 = $61.71
Facility: (1 × 1 + 0.25 × 1.011 + 0.07 × 0.985) × $33.4009 = $44.15
Payment rules and modifiers for 99425
The CMS indicators that decide how 99425 is paid alongside other services.
CMS payment indicators · 99425
Principal care management, each additional 30 minutes
| Rule | CMS value | What it means |
|---|---|---|
| Global period | ZZZ | Add-on code: falls within the primary procedure’s global period. |
| Multiple procedures | 0 | No multiple-procedure reduction. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 0 | Not paid without supporting documentation. |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
How 99425 has changed in Puerto Rico
99425 · Office / nonfacility
$61.71
Effective 2026-10-01
The base rate is $2.70 higher than on 2025-10-01, moving from $59.01 to $61.71 (4.6%).
It is unchanged from the immediately preceding available release, effective 2026-07-01.
One bar per available release, ordered by effective date. Missing rates remain gaps. These comparisons hold the code, setting and locality identifiers constant; they do not isolate which policy or input caused a change.
What changed, release by release
January 1, 2026
RVU26A
$59.01changed to$61.71
- Conversion factor 32.3465 changed to 33.4009
- Practice expense RVU 0.76 changed to 0.77
- Malpractice RVU 0.06 changed to 0.07
- Practice expense GPCI 1.007 changed to 1.011
- Malpractice GPCI 0.982 changed to 0.985
Held through RVU26B, RVU26C, RVU26D.
January 1, 2025
RVU25A
$60.05changed to$59.01
- Conversion factor 33.2875 changed to 32.3465
- Practice expense RVU 0.73 changed to 0.76
- Malpractice RVU 0.07 changed to 0.06
Held through RVU25B, RVU25C, RVU25D.
March 9, 2024
RVU24AR
$59.07changed to$60.05
- Conversion factor 32.7442 changed to 33.2875
Held through RVU24B, RVU24C, RVU24D.
January 1, 2024
RVU24A
$58.42changed to$59.07
- Conversion factor 33.8872 changed to 32.7442
- Practice expense RVU 0.65 changed to 0.73
- Practice expense GPCI 1.008 changed to 1.007
- Malpractice GPCI 0.984 changed to 0.982
October 1, 2023
RVU23D
$58.29changed to$58.42
- Practice expense GPCI 1.000 changed to 1.008
- Malpractice GPCI 1.000 changed to 0.984
January 1, 2023
RVU23A
$60.36changed to$58.29
- Conversion factor 34.6062 changed to 33.8872
- Practice expense RVU 0.66 changed to 0.65
- Malpractice RVU 0.08 changed to 0.07
- Practice expense GPCI 1.008 changed to 1.000
- Malpractice GPCI 0.986 changed to 1.000
Held through RVU23B, RVU23C.
January 1, 2022
RVU22A
No ratechanged to$60.36
Held through RVU22B, RVU22C, RVU22D.
January 1, 2013
RVU13AR
Earliest loaded release: No rate
Held through RVU13B, RVU13C, RVU13D, RVU14A, RVU14B, RVU14C, RVU14D, RVU15A, RVU15B, RVU15C, RVU15D, RVU16A, RVU16B, RVU16C, RVU16D, RVU17A, RVU17B, RVU17C, RVU17D, RVU18AR1, RVU18B, RVU18C, RVU18D, RVU19A, RVU19B, RVU19C, RVU19D, RVU20A, RVU20B, RVU20C, RVU20D, RVU21A, RVU21B, RVU21C, RVU21D.
| Effective from | Office | Facility | CMS release |
|---|---|---|---|
| 2026-10-01 | $61.71 | $44.15 | RVU26D |
| 2026-07-01 | $61.71 | $44.15 | RVU26C |
| 2026-04-01 | $61.71 | $44.15 | RVU26B |
| 2026-01-01 | $61.71 | $44.15 | RVU26A |
| 2025-10-01 | $59.01 | $49.24 | RVU25D |
| 2025-07-01 | $59.01 | $49.24 | RVU25C |
| 2025-04-01 | $59.01 | $49.24 | RVU25B |
| 2025-01-01 | $59.01 | $49.24 | RVU25A |
| 2024-10-01 | $60.05 | $50.66 | RVU24D |
| 2024-07-01 | $60.05 | $50.66 | RVU24C |
| 2024-04-01 | $60.05 | $50.66 | RVU24B |
| 2024-03-09 | $60.05 | $50.66 | RVU24AR |
| 2024-01-01 | $59.07 | $49.83 | RVU24A |
| 2023-10-01 | $58.42 | $50.91 | RVU23D |
| 2023-07-01 | $58.29 | $50.83 | RVU23C |
| 2023-04-01 | $58.29 | $50.83 | RVU23B |
| 2023-01-01 | $58.29 | $50.83 | RVU23A |
| 2022-10-01 | $60.36 | $52.68 | RVU22D |
| 2022-07-01 | $60.36 | $52.68 | RVU22C |
| 2022-04-01 | $60.36 | $52.68 | RVU22B |
| 2022-01-01 | $60.36 | $52.68 | RVU22A |
| 2021-10-01 | Not in this release | Not in this release | RVU21D |
| 2021-07-01 | Not in this release | Not in this release | RVU21C |
| 2021-04-01 | Not in this release | Not in this release | RVU21B |
| 2021-01-01 | Not in this release | Not in this release | RVU21A |
| 2020-10-01 | Not in this release | Not in this release | RVU20D |
| 2020-07-01 | Not in this release | Not in this release | RVU20C |
| 2020-04-01 | Not in this release | Not in this release | RVU20B |
| 2020-01-01 | Not in this release | Not in this release | RVU20A |
| 2019-10-01 | Not in this release | Not in this release | RVU19D |
| 2019-07-01 | Not in this release | Not in this release | RVU19C |
| 2019-04-01 | Not in this release | Not in this release | RVU19B |
| 2019-01-01 | Not in this release | Not in this release | RVU19A |
| 2018-10-01 | Not in this release | Not in this release | RVU18D |
| 2018-07-01 | Not in this release | Not in this release | RVU18C |
| 2018-04-01 | Not in this release | Not in this release | RVU18B |
| 2018-01-01 | Not in this release | Not in this release | RVU18AR1 |
| 2017-10-01 | Not in this release | Not in this release | RVU17D |
| 2017-07-01 | Not in this release | Not in this release | RVU17C |
| 2017-04-01 | Not in this release | Not in this release | RVU17B |
| 2017-01-01 | Not in this release | Not in this release | RVU17A |
| 2016-10-01 | Not in this release | Not in this release | RVU16D |
| 2016-07-01 | Not in this release | Not in this release | RVU16C |
| 2016-04-01 | Not in this release | Not in this release | RVU16B |
| 2016-01-01 | Not in this release | Not in this release | RVU16A |
| 2015-10-01 | Not in this release | Not in this release | RVU15D |
| 2015-07-01 | Not in this release | Not in this release | RVU15C |
| 2015-04-01 | Not in this release | Not in this release | RVU15B |
| 2015-01-01 | Not in this release | Not in this release | RVU15A |
| 2014-10-01 | Not in this release | Not in this release | RVU14D |
| 2014-07-01 | Not in this release | Not in this release | RVU14C |
| 2014-04-01 | Not in this release | Not in this release | RVU14B |
| 2014-01-01 | Not in this release | Not in this release | RVU14A |
| 2013-10-01 | Not in this release | Not in this release | RVU13D |
| 2013-07-01 | Not in this release | Not in this release | RVU13C |
| 2013-04-01 | Not in this release | Not in this release | RVU13B |
| 2013-01-01 | Not in this release | Not in this release | RVU13AR |
Where the Puerto Rico rate applies
Puerto Rico is a Medicare payment area, not a city. Our Census mapping connects it to 292 cities and communities in Puerto Rico. Some span more than one payment area; confirm with the service ZIP.
- Aceitunas
- Adjuntas
- Aguada
- Aguadilla
- Aguas Buenas
- Aguas Claras
- Aguilita
- Aibonito
99425 billing questions
When should 99425 be reported instead of 99424?
99424 reports the initial physician or qualified professional principal care management time for the month. Report 99425 for each additional 30-minute increment after that initial service, with 99424 as the primary code.
Can 99425 be billed by itself?
No. CMS identifies it as an add-on code that must be billed with a primary procedure; for this service, pair it with 99424.
What documentation supports an additional unit?
Document the qualifying high-risk condition, the condition-specific care management performed, and the additional time accumulated during the calendar month. The record should also support the care plan and coordination activities.
Can clinical staff time be counted toward 99425?
99425 represents additional physician or other qualified health care professional time. The clinical-staff principal care management codes are 99426 and 99427.
Is 99425 reported once per month or for each increment?
It is reported for each additional 30-minute increment of qualifying physician or qualified professional time in the calendar month, alongside the initial service reported with 99424.
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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