CPT Code | Description | 2026 National Average (Approx.):
| 99424 | First 30 min, physician/QHP time | ~$89 |
| 99425 | Each additional 30 min, physician/QHP time (add-on to 99424) | ~$63 |
| 99426 | First 30 min, clinical staff time | ~$62 |
| 99427 | Each additional 30 min, clinical staff time (add-on to 99426) | ~$50 |
PCM codes share similar rate structures with their CCM counterparts (99424/99425 mirror 99491/99437 in structure; 99426/99427 mirror 99490/99439). The key clinical distinction remains: PCM is for a single qualifying condition; CCM requires two or more.
Sources:
CMS CY 2026 PFS Final Rule; CMS PFS Relative Value Files.
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