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

In Washington, DC area, Medicare pays $75.58 for 99426 in the office and $47.64 when it’s performed in a hospital or facility.

Check a contract rate as a % of Medicare · 99426 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 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.

How Washington, DC area compares for 99426

Across 109 of 109 payment localities, the office rate for 99426 runs from $62.15 in Arkansas to $85.54 in Alaska. Washington, DC area pays $75.58. The RVUs are the same everywhere; the geographic indexes change the dollars.

Every other payment area

99426 rates by state

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

See 99426 in every payment locality

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.

Codes related to 99426

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

How 99426 has changed in Washington, DC area

Price 99426 for an earlier date of service

Where the Washington, DC area rate applies

Washington, DC area is a Medicare payment area, not a city. Our Census mapping connects it to 1 cities and communities in District of Columbia. Some span more than one payment area; confirm with the service ZIP.

• Washington

Browse all communities in District of Columbia

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