Part of Principal Care Management
CPT 99426: Principal Care Management, clinical staff time, first 30 minutes
First 30 minutes per calendar month of principal care management furnished by clinical staff under the direction of a physician or qualified health professional.
Time threshold & code combinations
First 30 minutes of clinical staff time per calendar month.
- 99427 is the add-on for each additional 30 minutes and cannot be billed without 99426 first in the same month
- Do not bill 99426 and 99424 for the same time period
Who can bill
- Clinical staff, under the general supervision of a physician or qualified health professional who bills the service
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
- Clinical staff time directed by the billing physician/QHP
- Coordination with other treating practitioners
When to use it
Care coordinator managing a single complex condition
A care coordinator spends 30 minutes contacting a specialist, updating the medication list, and documenting changes to the care plan for a patient with severe asthma, under the supervising physician's direction.
Billing: 99426
Documentation checklist
- Time log attributing minutes to clinical staff
- Evidence of physician/QHP direction and oversight
- Condition-specific care plan entry or revision
Common billing mistakes
- Billing staff time under 99424 instead of 99426
- No documented supervising physician/QHP direction