Part of Principal Care Management
CPT 99425: Principal Care Management, physician/QHP time, each additional 30 minutes
Add-on code for each additional 30 minutes of physician/QHP PCM time beyond the first 30 minutes.
Time threshold & code combinations
Each additional 30 minutes of physician/QHP time, beyond the 99424 threshold, per calendar month.
- Cannot be billed without 99424 in the same calendar month
- Can be reported more than once if additional 30-minute increments are met and documented
Who can bill
- Physicians
- Qualified health professionals
Eligibility & billing requirements
- Same eligibility as 99424
- 99424 must be billed first for the same month
- Only reported after the first 30 minutes (99424) have been met
- Additional time must be personally spent by the physician/QHP
When to use it
Extended medication titration
After the first 30 minutes managing a complex heart failure regimen, the physician spends another 30 minutes coordinating with a cardiologist and updating the care plan.
Billing: 99424 + 99425
Documentation checklist
- Time log showing the additional 30-minute increment
- Confirmation that 99424 was met first in the same month
Common billing mistakes
- Billing 99425 without 99424 in the same month
- Rounding up to claim an additional 30-minute increment that wasn't actually met