CPT 99424: Principal Care Management — First 30 Minutes (Physician).
CPT 99424 covers the first 30 minutes of physician or qualified healthcare professional time per calendar month for principal care management of a single high-risk chronic condition expected to last at least 3 months. PCM is designed for patients who need intensive management of one dominant condition rather than multi-condition coordination. Important: unlike CCM where 99490 is the staff code, PCM 99424/99425 is the physician track and 99426/99427 is the staff track.
Quick Answer
What is CPT 99424?
CPT 99424 is the Medicare billing code for Principal Care Management (PCM), covering the first 30 minutes of physician or QHP time per calendar month for a single high-risk chronic condition. It reimburses approximately $88 per month under the 2026 fee schedule. Unlike CCM (99490) which requires two chronic conditions and uses clinical staff time, PCM focuses on one dominant condition with direct physician involvement. Important: PCM code numbering is opposite from CCM — 99424/99425 is the physician track, 99426/99427 is the staff track. PCM and CCM cannot be billed in the same month.
Documentation
Documentation requirements.
Identification of the single high-risk chronic condition being managed with ICD-10 code
Documentation of why the condition meets the 'high-risk' criteria (risk of hospitalization, exacerbation, or functional decline)
Disease-specific care plan focused exclusively on the principal condition
Physician/QHP personal time log with dates, durations, and descriptions of PCM activities totaling 30+ minutes
Patient consent for PCM services documented in the medical record
Clinical rationale for ongoing intensive management of the condition
Scenarios
Common billing scenarios.
Physician manages uncontrolled heart failure
BillableA physician personally spends 35 minutes during the month managing a patient with NYHA Class III heart failure — reviewing weight trends, adjusting diuretics, coordinating with cardiology, and calling the patient about fluid restriction. The single high-risk condition focus justifies PCM.
Patient has three chronic conditions requiring management
Not BillableA patient has hypertension, diabetes, and depression — all requiring active management. Because the patient has multiple conditions that each need care coordination, CCM (99490) is more appropriate than PCM (99424), which focuses on a single dominant condition.
PCM billed alongside RPM for the same condition
BillableA patient with uncontrolled diabetes receives PCM for intensive glucose management (physician coordinates care) and RPM for continuous glucose monitoring. Both services relate to the same condition and can be billed concurrently with separate time documentation.
PCM and CCM billed in the same month for the same patient
Not BillableA practice attempts to bill both 99424 (PCM) and 99490 (CCM) for the same patient in the same calendar month. These services are mutually exclusive — a patient receives either PCM or CCM in a given month, not both.
FAQ
Common questions about CPT 99424.
What is CPT 99424?
CPT 99424 is the Medicare billing code for Principal Care Management (PCM), covering the first 30 minutes of physician or qualified healthcare professional time per calendar month for managing a single high-risk chronic condition expected to last at least 3 months. It reimburses approximately $88 per month under the 2026 Medicare fee schedule.
How much does CPT 99424 reimburse in 2026?
CPT 99424 reimburses approximately $88 per patient per month under the 2026 Medicare Physician Fee Schedule. The add-on code 99425 covers each additional 30 minutes of physician time at approximately $61 per unit. For practices using clinical staff, the PCM staff track (99426 at ~$68 base) is an alternative.
What is the difference between PCM (99424) and CCM (99490)?
PCM focuses on a single high-risk condition lasting 3+ months, while CCM requires two or more chronic conditions lasting 12+ months. PCM 99424 requires 30 minutes of physician time ($88); CCM 99490 requires 20 minutes of clinical staff time ($62). PCM and CCM cannot be billed for the same patient in the same month. PCM is ideal when one dominant condition drives the majority of care needs.
Why is 99424 the physician code and not the staff code?
PCM code numbering is opposite from CCM convention, which can cause confusion. In PCM: 99424/99425 is the physician/QHP track, while 99426/99427 is the clinical staff track. In CCM: 99490 is the staff code and 99491 is the physician code. Always verify whether you are billing physician time or staff time and select the correct PCM track accordingly.
Can PCM and RPM be billed together?
Yes, PCM and RPM can be billed concurrently for the same patient in the same month, provided the RPM monitoring relates to the principal condition being managed under PCM. Time must be tracked separately for each service. For example, a patient with uncontrolled heart failure could receive PCM for care management and RPM for remote weight and blood pressure monitoring.
What conditions qualify as 'high-risk' for PCM?
High-risk conditions for PCM include any chronic condition lasting 3+ months that places the patient at significant risk of hospitalization, acute exacerbation, functional decline, or death. Common examples include uncontrolled heart failure (NYHA III/IV), poorly controlled diabetes with complications, advanced CKD (stage 3-5), COPD with frequent exacerbations, and active cancer undergoing treatment.
Related Codes
Other CPT codes.
CCM Initial 20 Minutes
$62.00 • Once per calendar month
RPM Device Supply (16+ Days)
$52.11 • Monthly (per 30-day period)
RPM Clinical Review (First 20 Min)
$51.77 • Once per calendar month
RPM Initial Setup (One-Time)
$21.71 • One-time per episode of care
RPM Clinical Review (Additional 20 Min)
$41.42 • Monthly (per calendar month, add-on to 99457)
Complex CCM Initial 30 Minutes
$86.00 • Once per calendar month
BHI Care Management (20 Min)
$53.00 • Once per calendar month