99424
Principal care management, first 30 minutes, practitioner
At least 30 minutes provided personally by the physician or other qualified health professional, per calendar month, for a single high risk condition.
CPT Codes
Principal care management CPT codes: 99424, 99425, 99426 and 99427
Principal care management covers a single high risk condition rather than the whole patient. That single condition focus is what separates it from chronic care management.
99425
Each additional 30 minutes, practitioner
Reported with 99424 for each further 30 minutes of practitioner time in the same calendar month.
99426
Principal care management, first 30 minutes, clinical staff
At least 30 minutes of clinical staff time directed by the practitioner under general supervision, per calendar month.
99427
Each additional 30 minutes, clinical staff
Reported with 99426 for each further 30 minutes of clinical staff time in the same calendar month.
The Distinction
How does this differ from chronic care management?
Principal care management addresses a single complex chronic condition. Chronic care management addresses a patient with two or more. The unit of focus, not the intensity, is what separates them.
This makes principal care management the natural fit for specialty practices, where the relationship with the patient is organized around one condition rather than around the whole person. A cardiology practice managing heart failure is doing principal care management even where the patient has other conditions managed elsewhere.
The condition has to be expected to last at least three months and to place the patient at significant risk of hospitalisation, acute exacerbation or decompensation, functional decline or death.
Structure
How are the four codes organized?
Two pairs. 99424 and 99425 cover practitioner time. 99426 and 99427 cover clinical staff time under general supervision. Within each pair the first code covers the initial 30 minutes and the second is the add-on.
Each pair works on a 30 minute increment, which differs from chronic care management, where the clinical staff codes run on 20 minute increments and the practitioner codes on 30. This asymmetry is a common source of error when a practice runs both programs.
The add-on codes cannot be reported unless the base code threshold has been met in the same calendar month.
Common Questions
Related questions
What is the difference between principal care management and chronic care management?
Principal care management covers a single complex chronic condition. Chronic care management requires two or more chronic conditions. A patient can be eligible for either depending on which practice is managing what, but the same practice does not report both for the same patient in the same month.
Who can furnish principal care management?
99424 and 99425 cover time provided personally by the physician or other qualified health professional. 99426 and 99427 cover clinical staff time under the practitioner's general supervision. The four codes are two alternatives, not a sequence.
How long must the condition be expected to last?
At least three months. This is shorter than the 12 month expectation used for chronic care management, and it is one of the reasons principal care management suits a post-acute or specialty episode that has a foreseeable end.
Can principal care management be billed with advanced primary care management?
No. Advanced primary care management bundles elements of principal care management, transitional care management and chronic care management, so it is not reported alongside them.
Is there a minimum time before anything can be billed?
Yes. Each base code requires its full 30 minutes within the calendar month. Below that threshold nothing is reportable, and the add-on codes only become available once the base threshold is met.
Code descriptors reflect the AMA CPT code set and the CMS HCPCS code set current as of CY2026. Both are revised annually, and Medicare Administrative Contractor and commercial payer policy varies. This page describes what each code covers and the conditions attached to reporting it. It is a reference, not billing advice for a specific claim, and it carries no payment rates.
Talk it through with someone who runs these programs
Praventa operates care management programs with its own clinical team and licenses the same platform to practices running them in-house. Describe your situation and we will tell you which model fits.