$58.98–$62.75
99424 covers the first 30 minutes of physician or qualified health professional principal care management in the month; 99425 covers each additional 30 minutes.
On this page
CMS RVU26D · Effective 2026-10-01
99424 Principal care management Medicare reimbursement rates in Texas
Reports the first 30 minutes of monthly physician or qualified health professional care management for one complex, high-risk chronic condition. Compare 99424 office and facility rates across CMS payment localities in Texas.
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 99424 in Texas?
Texas has 8 payment localities in this comparison. Use the service location to choose the applicable amount. These are the supported base rates for the 8 payment areas shown below, using the same CMS release.
Office / nonfacility
$84.06–$89.24
8 of 8 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.
Where 99424 pays more and less in Texas
8 payment localities
$84.06 to $89.24
Care management
About 99424: Physician principal care management, first 30 minutes
Reports the first 30 minutes of monthly physician or qualified health professional care management for one complex, high-risk chronic condition.
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.
Where the value comes from
- Work RVU1.45 · 55%
- Practice expense (office) RVU1.06 · 40%
- Malpractice RVU0.11 · 4%
85K
Medicare services in 2024 · #611 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.
99424 compared with similar codes
Office rates for Texas, from the same CMS release.
$64.75–$69.46
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.
$85.72–$91.03
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.
Compare 99424 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.
8 of 8 payment localities
| Payment locality | Office | Facility |
|---|---|---|
| Austin | Office $89.24 | Facility $65.21 |
| Beaumont | Office $84.06 | Facility $63.39 |
| Brazoria | Office $86.77 | Facility $64.26 |
| Dallas | Office $87.28 | Facility $64.66 |
| Fort Worth | Office $86.98 | Facility $64.58 |
| Galveston | Office $87.02 | Facility $64.46 |
| Houston | Office $89.03 | Facility $66.48 |
| Rest Of Texas | Office $85.35 | Facility $63.79 |
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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 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.
13,10299421,,Ol dig e/m svc 5-10 min,A,,0.25,0.20,,0.06,,0.02,0.47,0.33,0,XXX,0.00,0.00,0.00,0,0,0,0,0,9,,33.4009,09,0,99,0.00,0.00,0.00
13,10399422,,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