What are the billing requirements for CPT 99426?

Requires a single complex chronic condition expected to last at least three months Minimum 30 minutes of clinical staff time per calendar month Frequently billed by specialists rather than primary care

Does Healthcare SBC handle billing for 99426?

Yes. Our certified coders bill 99426 routinely as part of full-service revenue cycle management, including documentation review, correct unit calculation where applicable, modifier application and denial management specific to this code.

CPT 99426Care Management

CPT Code 99426: Principal Care Management, First 30 Minutes

Principal care management, first 30 minutes

CPT 99426 covers the first 30 minutes of principal care management per calendar month for a patient with a single complex chronic condition.

What this code covers

Unlike CCM, principal care management addresses one high-risk chronic condition rather than two or more.

Typically used by specialists managing a single condition requiring disease-specific care planning.

Requires a documented disease-specific care plan and ongoing communication.

Billing and documentation notes

Requires a single complex chronic condition expected to last at least three months
Minimum 30 minutes of clinical staff time per calendar month
Frequently billed by specialists rather than primary care

Related codes

CPT is a registered trademark of the American Medical Association. This page provides a general summary for educational purposes and is not a substitute for the official CPT code set, payer policy or professional coding judgment. Verify against current official descriptors and applicable payer policy before billing.

FAQ

CPT 99426, frequently asked questions questions

What is CPT code 99426?: CPT 99426 covers the first 30 minutes of principal care management per calendar month for a patient with a single complex chronic condition.
What are the billing requirements for CPT 99426?: Requires a single complex chronic condition expected to last at least three months Minimum 30 minutes of clinical staff time per calendar month Frequently billed by specialists rather than primary care
Does Healthcare SBC handle billing for 99426?: Yes. Our certified coders bill 99426 routinely as part of full-service revenue cycle management, including documentation review, correct unit calculation where applicable, modifier application and denial management specific to this code.

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