CPT 99425: PCM add-on by physician
An add-on reported with 99424 for each additional 30 minutes of practitioner time on the single qualifying condition.
CPT 99425 at a glance
- Time threshold
- Each additional 30 minutes of practitioner time
- Who performs it
- The physician or other qualified practitioner personally
- How often
- Add-on to 99424; monthly unit limits apply
- Approx. 2026 national rate
- ~$61
What the record needs to show
- 99424 supported for the same patient and month
- Time log showing minutes beyond the first 30
- Care plan and consent already on file
Common billing mistakes
- Reporting 99425 with the clinical staff code 99426
- Exceeding the monthly add-on limit
Where Zenith fits
Your practice stays the billing provider for CPT 99425. 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.