Part of Principal Care Management
CPT 99424: Principal Care Management, physician/QHP time, first 30 minutes
First 30 minutes per calendar month of principal care management furnished personally by a physician or qualified health professional.
Time threshold & code combinations
First 30 minutes of physician/QHP time per calendar month.
- 99425 is the add-on for each additional 30 minutes and cannot be billed without 99424 first in the same month
- Do not bill 99424 and 99426 for the same time period: choose physician/QHP time or clinical staff time, not both, for the same minutes
Who can bill
- Physicians
- Qualified health professionals (e.g., nurse practitioners, physician assistants)
Eligibility & billing requirements
- Single complex chronic condition expected to last at least 3 months, with significant risk as described in the program overview
- Documented consent
- A condition-specific care plan established or revised during the service period
- Time personally spent by the billing physician/QHP, not delegated staff time
- Coordination with other treating practitioners
When to use it
New complex diagnosis requiring active management
A physician spends 30 minutes personally reviewing labs, adjusting medications, and updating the care plan for a patient with newly diagnosed heart failure.
Billing: 99424
Specialist managing one dominant condition
A nephrologist personally coordinates dialysis planning and medication adjustments for a patient with advanced CKD as the sole qualifying condition.
Billing: 99424
Documentation checklist
- Time log attributing minutes to the physician/QHP personally
- Condition-specific care plan entry or revision
- Coordination notes with other practitioners
Common billing mistakes
- Logging clinical staff time under 99424 instead of using 99426
- Billing without a documented care plan revision or review for the month