$84.90–$88.79
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.
On this page
CMS RVU26D · Effective 2026-10-01
99426 Principal care management Medicare reimbursement rates in Michigan
Reports the first 30 minutes of clinical-staff work in a calendar month managing one complex chronic condition under physician or qualified professional direction. Compare 99426 office and facility rates across CMS payment localities in Michigan.
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 99426 in Michigan?
Michigan has 2 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 2 payment areas shown below, using the same CMS release.
Office / nonfacility
$65.32–$68.29
2 of 2 localities have a supported rate.
Facility setting
$43.66–$45.40
2 of 2 localities have a supported rate.
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 99426: Clinical-staff principal care management
Reports the first 30 minutes of clinical-staff work in a calendar month managing one complex chronic condition under physician or qualified professional direction.
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.
Where the value comes from
- Work RVU1.00 · 49%
- Practice expense (office) RVU0.96 · 47%
- Malpractice RVU0.07 · 3%
485.9K
Medicare services in 2024 · #234 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.
99426 compared with similar codes
Office rates for Michigan, from the same CMS release.
$59.52–$62.16
99425 reports additional PCM time furnished by the physician or qualified professional. 99426 is the initial staff-time code.
$51.83–$54.25
99427 reports each additional 30 minutes of staff PCM time after the initial increment represented by 99426.
$48.44–$50.69
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.
Compare 99426 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.
2 of 2 payment localities
Detroit →
Office / nonfacility
$68.29
Facility
$45.40
Rest Of Michigan →
Office / nonfacility
$65.32
Facility
$43.66
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99426 billing questions
When should staff report 99426 instead of 99424?
Use 99426 for qualifying clinical-staff time under physician or qualified professional direction. Code 99424 represents the initial 30 minutes of the physician’s or qualified professional’s own PCM time.
What code reports PCM staff time beyond the first 30 minutes?
99427 is the add-on code for each additional 30 minutes of qualifying clinical-staff time in the calendar month.
Can 99426 be reported with fewer than 30 minutes?
99426 represents the initial 30-minute increment. The record should support at least 30 minutes of qualifying staff work during that calendar month.
What should the record show?
Document the complex chronic condition, the disease-specific care plan, the staff’s care-management activities and direction, and the total qualifying staff time for the month.
Can the same staff minutes support another time-based service?
Do not count the same minutes twice. Track time attributed to PCM separately from time attributed to other services.
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.
13,10499423,,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
13,11099437,,Chrnc care mgmt phys ea addl,A,,1.00,0.82,,0.24,,0.07,1.89,1.31,0,ZZZ,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00