Part of Principal Care Management
CPT 99427: Principal Care Management, clinical staff time, each additional 30 minutes
Add-on code for each additional 30 minutes of clinical staff PCM time beyond the first 30 minutes.
Time threshold & code combinations
Each additional 30 minutes of clinical staff time, beyond the 99426 threshold, per calendar month.
- Cannot be billed without 99426 in the same calendar month
- Can be reported more than once if additional 30-minute increments are met and documented
Who can bill
- Clinical staff, under the direction of the billing physician/QHP
Eligibility & billing requirements
- Same eligibility as 99426
- 99426 must be billed first for the same month
- Only reported after the first 30 minutes (99426) have been met
- Additional time must be clinical staff time directed by the billing physician/QHP
When to use it
Extended coordination for a single condition
After the first 30 minutes, staff spend another 30 minutes coordinating durable medical equipment and follow-up appointments tied to the same qualifying condition.
Billing: 99426 + 99427
Documentation checklist
- Time log showing the additional 30-minute increment
- Confirmation that 99426 was met first in the same month
Common billing mistakes
- Billing 99427 without 99426 in the same month
- Logging time spent on an unrelated condition under this code