Billing code 99424: Principal care managementMedicare rate & RVUs
Reports the first 30 minutes of monthly physician or qualified health professional care management for one complex, high-risk chronic condition.
Medicare pays $87.51 for 99424 nationally in the office and $64.80 in a hospital or facility. Local office rates run $80.74–$112.38.
Medicare rate · 99424
Principal care management
Swap in your local Medicare rate.
- Work RVUs
- 1.45
- Total RVUs
- 2.62
- Global days
- XXX
National rate · 2026
$87.51
Office setting, before claim adjustments.
See every locality for 99424 → · Billed by an NP, PA or therapist? →
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 10 sections
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
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
109 payment localities
$80.74 to $112.38
109 of 109 payment localities
99424 rates by state
Office rate range in each state. Select a state to see its payment localities.
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Local rates. Clear comparisons.
Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.
$80.74
$112.38
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 | $112.38 | 1 |
| AL | $81.49 | 1 |
| AR | $80.74 | 1 |
| AZ | $85.88 | 1 |
| CA | $90.03–$106.78 | 29 |
| CO | $89.55 | 1 |
| CT | $91.98 | 1 |
| DC | $96.84 | 1 |
| DE | $86.96 | 1 |
| FL | $87.80–$94.58 | 3 |
| GA | $84.39–$88.96 | 2 |
| GU | $90.81 | 1 |
| HI | $90.81 | 1 |
| IA | $82.29 | 1 |
| ID | $82.74 | 1 |
| IL | $86.50–$92.78 | 4 |
| IN | $83.04 | 1 |
| KS | $82.29 | 1 |
| KY | $83.27 | 1 |
| LA | $83.28–$85.92 | 2 |
| MA | $89.42–$95.96 | 2 |
| MD | $88.12–$96.84 | 3 |
| ME | $83.29–$85.84 | 2 |
| MI | $84.90–$88.79 | 2 |
| MN | $85.95 | 1 |
| MO | $82.53–$85.82 | 3 |
| MS | $81.63 | 1 |
| MT | $87.50 | 1 |
| NC | $83.81 | 1 |
| ND | $85.33 | 1 |
| NE | $82.50 | 1 |
| NH | $88.50 | 1 |
| NJ | $93.06–$96.48 | 2 |
| NM | $85.31 | 1 |
| NV | $86.93 | 1 |
| NY | $84.65–$100.45 | 5 |
| OH | $84.46 | 1 |
| OK | $82.90 | 1 |
| OR | $86.28–$91.27 | 2 |
| PA | $84.41–$90.54 | 2 |
| PR | $87.84 | 1 |
| RI | $89.20 | 1 |
| SC | $84.27 | 1 |
| SD | $85.07 | 1 |
| TN | $82.59 | 1 |
| TX | $84.06–$89.24 | 8 |
| UT | $85.01 | 1 |
| VA | $85.83–$96.84 | 2 |
| VI | $87.84 | 1 |
| VT | $85.34 | 1 |
| WA | $89.14–$97.30 | 2 |
| WI | $83.48 | 1 |
| WV | $84.46 | 1 |
| WY | $86.56 | 1 |
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
Swap in your local Medicare rate.
Work 1.45Practice expense 1.06Malpractice 0.11
All indexes start 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).
Non-facility (office) rate · national
$87.51
The facility rate would be $64.80 (+$22.71). In a facility, the facility bills its own costs separately.
99424 compared with similar codes
Compare codes
99424 vs 99425 vs 99426 vs 99491: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99425Principal care management
- 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 management
- 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 management
- 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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