Billing code 99427: Principal care managementMedicare rate & RVUs
Reports each additional 30 minutes of clinical staff principal care management for a patient with a serious, complex chronic condition during a calendar month.
Medicare pays $54.11 for 99427 nationally in the office and $31.40 in a hospital or facility. Local office rates run $49.25–$68.64.
Medicare rate · 99427
Principal care management
Swap in your local Medicare rate.
- Work RVUs
- 0.71
- Total RVUs
- 1.62
- Global days
- ZZZ
National rate · 2026
$54.11
Office setting, before claim adjustments.
See every locality for 99427 → · 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 99427 covers
This code covers an additional 30 minutes of clinical staff work in principal care management for a patient with a single serious, complex chronic condition. The work centers on the condition-specific care plan and may include coordinating care with other clinicians, supporting medication management, and following up on changes that affect the patient’s disease. Clinical staff perform the work under a physician’s or other qualified health care professional’s direction, commonly as part of outpatient care for a condition that creates substantial risk of worsening or functional decline.
Report 99427 only after the initial clinical staff principal care management interval is represented by 99426. The record should identify the condition and care plan, describe the staff activities, and support the additional time counted during the calendar month. CMS classifies 99427 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.
Where 99427 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
$49.25 to $68.64
109 of 109 payment localities
99427 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.
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$49.25
$67.08
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 | $67.08 | 1 |
| AL | $49.79 | 1 |
| AR | $49.25 | 1 |
| AZ | $52.98 | 1 |
| CA | $56.50–$68.64 | 29 |
| CO | $55.87 | 1 |
| CT | $57.15 | 1 |
| DC | $60.69 | 1 |
| DE | $53.71 | 1 |
| FL | $53.69–$57.84 | 3 |
| GA | $51.33–$54.98 | 2 |
| GU | $57.34 | 1 |
| HI | $57.34 | 1 |
| IA | $50.66 | 1 |
| ID | $50.93 | 1 |
| IL | $52.55–$56.58 | 4 |
| IN | $51.15 | 1 |
| KS | $50.52 | 1 |
| KY | $50.78 | 1 |
| LA | $50.74–$52.64 | 2 |
| MA | $55.67–$60.47 | 2 |
| MD | $54.55–$60.69 | 3 |
| ME | $51.18–$53.23 | 2 |
| MI | $51.83–$54.25 | 2 |
| MN | $53.77 | 1 |
| MO | $50.10–$52.73 | 3 |
| MS | $49.68 | 1 |
| MT | $54.11 | 1 |
| NC | $51.58 | 1 |
| ND | $53.12 | 1 |
| NE | $50.86 | 1 |
| NH | $55.08 | 1 |
| NJ | $57.86–$60.31 | 2 |
| NM | $52.06 | 1 |
| NV | $53.86 | 1 |
| NY | $52.18–$62.49 | 5 |
| OH | $51.62 | 1 |
| OK | $50.66 | 1 |
| OR | $53.50–$57.25 | 2 |
| PA | $51.66–$56.04 | 2 |
| PR | $54.40 | 1 |
| RI | $55.33 | 1 |
| SC | $51.68 | 1 |
| SD | $53.00 | 1 |
| TN | $50.72 | 1 |
| TX | $51.41–$55.63 | 8 |
| UT | $52.22 | 1 |
| VA | $53.13–$60.69 | 2 |
| VI | $54.40 | 1 |
| VT | $53.00 | 1 |
| WA | $55.54–$61.51 | 2 |
| WI | $51.75 | 1 |
| WV | $51.07 | 1 |
| WY | $53.68 | 1 |
How the 99427 rate is calculated
Each of 99427’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 · 99427
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 0.71Practice expense 0.86Malpractice 0.05
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 99427
The CMS indicators that decide how 99427 is paid alongside other services.
CMS payment indicators · 99427
Principal care management
| 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. |
99427 compared with similar codes
Compare codes
99427 vs 99426 vs 99425 vs 99439: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 99426Principal care management
- Use 99426 for the initial clinical staff principal care management interval; use 99427 for additional time and report it with 99426.
- 99425Principal care management
- 99425 represents additional principal care management time furnished by a physician or other qualified professional. 99427 represents additional clinical staff time.
- 99439Chronic care management
- 99439 is an additional-time code for chronic care management by clinical staff. 99427 is for principal care management focused on a single serious, complex chronic condition.
99427 billing questions
What code must be reported with 99427?
Report 99427 with 99426, which represents the initial clinical staff principal care management interval. 99427 accounts for additional staff time.
How is 99427 different from 99426?
99426 reports the initial 30 minutes of clinical staff principal care management. 99427 reports each additional 30 minutes in the same calendar month.
How does 99427 differ from 99425?
Both are additional principal care management codes, but 99427 is for clinical staff time and 99425 is for physician or other qualified health care professional time.
What documentation supports an additional unit?
Document the serious chronic condition, its care plan, the clinical staff activities performed, and the time supporting the additional interval during the calendar month.
Can 99427 be reported by itself?
No. It is an add-on code and must be billed with its primary code, 99426.
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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