CPT 99427: PCM add-on by staff
An add-on reported with 99426 for each additional 30 minutes of clinical staff time on the qualifying condition.
CPT 99427 at a glance
- Time threshold
- Each additional 30 minutes of clinical staff time
- Who performs it
- Clinical staff under the billing practitioner's direction
- How often
- Add-on to 99426; up to twice per month
- Approx. 2026 national rate
- ~$54
What the record needs to show
- 99426 supported for the same patient and month
- Time log showing staff minutes in 30-minute blocks beyond the first 30
- Care plan and consent already on file
Common billing mistakes
- Reporting a block that was only partly completed
- Using 99427 with the physician-time code 99424
Where Zenith fits
Your practice stays the billing provider for CPT 99427. 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.