CPT 99426: PCM by staff, 30 min
Monthly management of one serious condition delivered by clinical staff under the practitioner's direction, starting at 30 minutes.
CPT 99426 at a glance
- Time threshold
- 30 minutes of clinical staff time per calendar month
- Who performs it
- Clinical staff under the billing practitioner's direction
- How often
- Once per patient per month
- Approx. 2026 national rate
- ~$68
Not reported with CCM for the same patient and month by the same practitioner, and not in the same month as the physician-time PCM codes 99424 and 99425.
What the record needs to show
- One complex chronic condition expected to last at least 3 months, with significant risk of decline
- A disease-specific care plan on file
- An initiating visit for new patients, or patients not seen within the past year, to explain PCM and get consent
- Documented consent and a staff time log reaching 30 minutes
Common billing mistakes
- Reporting fewer than 30 minutes
- Billing 99426 alongside CCM for the same patient and month
Where Zenith fits
Your practice stays the billing provider for CPT 99426. 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.