CPT 99426 and 99427: Time Requirements for Principal Care Management
CPT 99426 and 99427 time requirements for principal care management: the 30-minute threshold, add-on limit, eligibility and what to document each month.
Reviewed by Muhammad Usman, PharmD, co-founder of Zenith Care Solutions.
Principal care management (PCM) is the monthly care management service for a patient whose main problem is one serious condition, not a long list. CPT 99426 and 99427 are the two PCM codes for clinical staff time. This guide explains the time rules, who can perform the work, who qualifies, and what the record must show.
It is based on CMS's June 2025 Chronic Care Management booklet (MLN909188) and the AAFP's summary of the PCM codes. CMS's summary of the CY 2026 Physician Fee Schedule final rule (effective January 1, 2026) highlights no change to these time rules, but codes and policies change every year, so confirm the current requirements before you bill.
What are CPT 99426 and 99427?
Short answer: 99426 is billed for the first 30 minutes of clinical staff time in a calendar month. 99427 is the add-on for each additional 30 minutes, up to two times per month.
| Code | Who performs the time | What it covers | |---|---|---| | 99424 | Physician or other qualified health care professional | First 30 minutes per month | | +99425 | Physician or other qualified health care professional | Each additional 30 minutes | | 99426 | Clinical staff, under the clinician's direction | First 30 minutes per month | | +99427 | Clinical staff, under the clinician's direction | Each additional 30 minutes (up to twice per month) |
How do the time thresholds work?
PCM is time based, and the month is a calendar month. Time does not carry over.
| Documented clinical staff time | What can be reported | |---|---| | Under 30 minutes | Nothing for PCM that month | | 30 to 59 minutes | 99426 | | 60 to 89 minutes | 99426 plus 99427 once | | 90 minutes or more | 99426 plus 99427 twice (the maximum) |
Never count the same minutes toward two billed services.
Who qualifies for PCM?
CMS describes PCM for a patient with one high-risk chronic condition expected to last at least 3 months that puts them at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death. In practice, the condition should also:
- Require a care plan that is developed, monitored or revised
- Need frequent medication adjustments or unusually complex management
- Involve ongoing coordination among the clinicians treating the patient
CMS also requires another initial visit after one year to continue PCM services.
If the patient has two or more chronic conditions, the usual fit is chronic care management instead. See CCM vs. RPM vs. PCM for how to choose.
What does the record need to show?
The documentation habits are close to CCM. For each patient and month, keep:
- A qualifying condition, with why it carries significant risk
- A current care plan for that condition, and the date it was last reviewed or revised
- A time log: the date, minutes, who did the work (name and role) and what was done
- Evidence of coordination with the other clinicians involved, such as the specialist and the primary care practitioner
- Supervision: the billing practitioner directs the clinical staff
Our time tracking guide shows what auditors look for in a time log, and the CPT 99490 documentation checklist covers the CCM version of the same record.
What are the common mistakes?
- Billing 99426 below 30 minutes. There is no partial credit. Under 30 minutes, nothing is reported.
- Billing 99427 a third time. The add-on stops at two units per month.
- Counting the same minutes twice, for example toward PCM and another care management service.
- Using PCM for a patient who really has multiple chronic conditions, where CCM fits better.
- Assuming PCM and CCM stack. The same practitioner generally cannot report both for one patient in one month.
How can a practice staff PCM without adding headcount?
PCM works best when one person owns the monthly outreach, the time log and the care plan reviews for each enrolled patient. Zenith provides clinical staff who work inside your EHR, log time as the work happens and send a per-patient monthly summary your billing team can attach to the claim. See the principal care management service page, or book a 15-minute call to talk through your specialty and patient volume.