CPT 99424: PCM by physician, 30 min
Monthly management of one serious, high-risk condition when the physician or qualified practitioner personally spends at least 30 minutes in the month.
CPT 99424 at a glance
- Time threshold
- 30 minutes of practitioner time per calendar month
- Who performs it
- The physician or other qualified practitioner personally
- How often
- Once per patient per month
- Approx. 2026 national rate
- ~$88
Not reported with CCM for the same patient and month by the same practitioner, and not in the same month as the staff-time PCM codes 99426 and 99427.
What the record needs to show
- One complex chronic condition expected to last at least 3 months, with significant risk of hospitalization, decline or death
- A disease-specific care plan developed, monitored or revised
- An initiating visit for new patients, or patients not seen within the past year, to explain PCM and get consent
- Documented consent and a practitioner time log
Common billing mistakes
- Using PCM for a patient with several conditions that fit CCM better
- Billing PCM and CCM for the same patient, month and practitioner
Where Zenith fits
Your practice stays the billing provider for CPT 99424. Zenith supplies trained clinical staff who do the work inside your EHR and invoice your practice for the labor. Zenith does not bill Medicare. See Principal Care Management for how the program runs.
Educational summary, not billing or legal advice. Rates are 2026 Medicare national averages and vary by locality and payer. Confirm current rules in the CMS Physician Fee Schedule and with your Medicare Administrative Contractor.