CPT code 99426: Principal care management, clinical staff, initial 30 minutes2026 Medicare rate & RVUs

Medicare pays $67.80 for 99426 nationally in the office and $44.09 in a hospital or facility. Local office rates run $62.15–$85.54.

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

What 99426 covers

99426 reports clinical-staff work in principal care management for a patient with one complex chronic condition expected to last at least three months and carrying significant risk, such as complex heart failure requiring ongoing medication and specialist coordination. Nursing staff perform the care-management work under a physician’s or other qualified health care professional’s direction. Activities may include implementing or revising a disease-specific care plan and coordinating with the patient, caregivers, and treating clinicians in an office or other care setting.

Report 99426 for the first 30 minutes of qualifying staff time in a calendar month; use 99427 for each additional 30 minutes. Physician or qualified professional time for this service is represented by 99424 and 99425, rather than staff time under 99426. Documentation should identify the condition and care plan, describe the work performed and staff direction, and record the qualifying minutes and month. The PFS assigns work, practice-expense, and malpractice RVUs, with separate office and facility practice-expense values.

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 99426 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

99426 rates by state

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

How the 99426 rate is calculated

Each of 99426’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 99426

99426 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.

99426 compared with similar codes

How to choose

99424Principal care managementPhysician/QHP, first 30 minutes

Choose 99424 for the initial 30 minutes of physician or qualified professional PCM time; choose 99426 for the initial 30 minutes of qualifying clinical-staff time.

99425Principal care managementEach additional 30 minutes

99425 reports additional PCM time furnished by the physician or qualified professional. 99426 is the initial staff-time code.

99427Principal care managementAdditional clinical staff time

99427 reports each additional 30 minutes of staff PCM time after the initial increment represented by 99426.

99439Chronic care managementClinical staff, each additional 20 minutes

99439 is an add-on for clinical-staff chronic care management time; 99426 reports the initial staff-time increment for principal care management focused on one complex chronic condition.

Codes related to 99426

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

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