$89.55
99424 covers the initial physician or qualified professional principal care management time for the month. Use 99425 only for additional time and report it with 99424.
On this page
CMS RVU26D · Effective 2026-10-01
99425 Principal care management Medicare reimbursement rates in Colorado
Reports each additional 30 minutes of physician or qualified professional time managing a single high-risk chronic condition during a calendar month. Compare 99425 office and facility rates across CMS payment localities in Colorado.
Amounts below use the non-QP conversion factor for participating physicians. These are base physician payments before claim-level adjustments, not patient costs or total hospital charges.
What does Medicare pay for 99425 in Colorado?
Colorado has 1 payment locality in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the payment area shown below, using the same CMS release.
Office / nonfacility
$62.99
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
Facility setting
$44.51
1 of 1 localities have a supported rate.
Payment area: Colorado
One mapped payment locality.
These are locality ranges, not averages or address-specific quotes. A facility-setting amount covers the physician service; it does not include a hospital’s separate bill. Choose a locality below to inspect its calculation, compare other payment areas, or price a percentage of Medicare.
Care management
About 99425: Additional physician principal care management time
Reports each additional 30 minutes of physician or qualified professional time managing a single high-risk chronic condition during a calendar month.
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.
CMS billing rules for 99425
- Global period
- Add-on code: billed only together with a primary procedure and paid within that procedure's global period.
Where the value comes from
- Work RVU1.00 · 54%
- Practice expense (office) RVU0.77 · 42%
- Malpractice RVU0.07 · 4%
12.7K
Medicare services in 2024 · #1354 by national volume
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.
99425 compared with similar codes
Office rates for Colorado, from the same CMS release.
$55.87
99427 captures additional principal care management time furnished by clinical staff. 99425 is for additional physician or qualified professional time.
$64.77
99437 is additional time for chronic care management; 99425 is additional time focused on managing a single high-risk chronic condition under principal care management.
Compare 99425 by payment locality
Find the payment area for your service address, then open its rate page for calculation inputs, release history and the percentage-of-Medicare tool. A city may cross payment-area boundaries; the ZIP lookup above helps resolve the location.
1 of 1 payment localities
Colorado →
Office / nonfacility
$62.99
Facility
$44.51
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How this local rate is calculated
Each RVU component is multiplied by its own geographic practice cost index (GPCI). The three adjusted components are added, then multiplied by the conversion factor. These are the inputs used for 99425 in Colorado.
PPRRVU2026_Oct_nonQPP.csv
13,106
- Code
- 99425
- Physician work
- 1.00
- Practice expense
- 0.77
- Malpractice
- 0.07
GPCI2026.csv
37
- Locality
- Colorado
- Physician work
- 1.012
- Practice expense
- 1.064
- Malpractice
- 0.781
| Component | RVU | Locality factor | Adjusted |
|---|---|---|---|
| Physician work | 1.00 | × 1.012 | 1.0120 |
| Practice expense | 0.77 | × 1.064 | 0.8193 |
| Malpractice | 0.07 | × 0.781 | 0.0547 |
| Total RVUs | 1.8860 | ||
| Conversion factor | × 33.4009 | ||
Office / nonfacility rate, Colorado$62.99
Explore RVUs, geographic factors and the full formula
Office / nonfacility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1 | 1.012 |
| Practice expense | 0.77 | 1.064 |
| Malpractice | 0.07 | 0.781 |
(1 × 1.012 + 0.77 × 1.064 + 0.07 × 0.781) × $33.4009 = $62.99
Facility
| Component | RVU | Local GPCI |
|---|---|---|
| Work | 1 | 1.012 |
| Practice expense | 0.25 | 1.064 |
| Malpractice | 0.07 | 0.781 |
(1 × 1.012 + 0.25 × 1.064 + 0.07 × 0.781) × $33.4009 = $44.51
The office and facility calculations use their respective practice-expense RVUs. The facility amount here is the physician fee, not a separate hospital or facility bill.
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 indices and the applicable conversion factor. Unavailable or separately priced services are labeled rather than assigned a made-up amount.
Source: RVU26D. Effective 2026-10-01 through the day before 2027-01-01.
13,10399422,,Ol dig e/m svc 11-20 min,A,,0.50,0.38,,0.13,,0.04,0.92,0.67,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10499423,,Ol dig e/m svc 21+ min,A,,0.80,0.61,,0.20,,0.05,1.46,1.05,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10599424,,Prin care mgmt phys 1st 30,A,,1.45,1.06,,0.38,,0.11,2.62,1.94,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10699425,,Prin care mgmt phys ea addl,A,,1.00,0.77,,0.25,,0.07,1.84,1.32,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10799426,,Prin care mgmt staff 1st 30,A,,1.00,0.96,,0.25,,0.07,2.03,1.32,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10899427,,Prin care mgmt staff ea addl,A,,0.71,0.86,,0.18,,0.05,1.62,0.94,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10999429,,Unlisted preventive service,N,,0.00,0.00,,0.00,,0.00,0.00,0.00,9,XXX,0.00,0.00,0.00,9,9,9,9,9,9,,33.4009,09,0,99,0.00,0.00,0.00
3401112,CA,69,VISALIA,1.017,1.096,0.536
3501112,CA,70,YUBA CITY,1.017,1.096,0.536
3601112,CA,75,REST OF CALIFORNIA,1.017,1.096,0.536
3704112,CO,01,COLORADO,1.012,1.064,0.781
3813102,CT,00,CONNECTICUT,1.020,1.077,1.210
3912202,DC,01,DC + MD/VA SUBURBS,1.054,1.178,1.113
4012102,DE,01,DELAWARE,1.005,0.988,0.899