CPT 99425

Principal Care Mgmt Svc Ea Adl 30 Phy/Qhp Cal Mo

CPT 99425 pays $61.46 in a non-facility setting and $44.09 in a facility setting under the 2026 Medicare Physician Fee Schedule, before geographic adjustment. After geographic adjustment, state amounts run from $56.70 in Arkansas to $78.78 in Alaska, a 39% spread.

National non-facility rate

$61.46

Office and other outpatient settings

Facility rate
$44.09

Hospital and ASC settings

Highest state
$78.78

Alaska

Lowest state
$56.70

Arkansas · 39% spread

Medicare rate by state

53 Medicare jurisdictions, highest to lowest. State values average every locality in the jurisdiction at a 33.4009 conversion factor.

Non-facilityFacilityNational $61.46
CPT 99425 Medicare reimbursement rate by state, 33.4009 conversion factor, 2026 Physician Fee Schedule. National non-facility $61.46, national facility $44.09.
StateRate compared visuallyNon-facilityFacility
Alaska
$78.78$60.28
District of Columbia
$68.10$47.64
New York
$66.85$47.48
New Jersey
$66.61$47.05
California
$66.30$45.75
Washington
$65.62$45.82
Massachusetts
$65.22$45.71
Connecticut
$64.60$45.89
Hawaii
$64.00$44.25
Florida
$63.76$46.33
Maryland
$63.17$45.06
Colorado
$62.99$44.51
Illinois
$62.84$46.05
Rhode Island
$62.69$44.75
Oregon
$62.45$44.16
New Hampshire
$62.22$44.14
Puerto Rico
$61.71$44.15
Virgin Islands
$61.71$44.15
Montana
$61.45$44.08
Pennsylvania
$61.39$44.38
Nevada
$61.09$43.71
Delaware
$61.08$43.92
Texas
$61.08$43.98
Wyoming
$60.85$43.48
Michigan
$60.84$44.53
Georgia
$60.78$44.21
Minnesota
$60.56$42.69
Virginia
$60.33$43.26
Arizona
$60.32$43.49
North Dakota
$60.07$42.70
Vermont
$60.05$42.85
South Dakota
$59.91$42.54
New Mexico
$59.79$43.87
Utah
$59.68$43.35
Maine
$59.44$42.84
Louisiana
$59.33$43.47
Missouri
$59.30$43.37
Ohio
$59.24$43.38
South Carolina
$59.15$43.10
West Virginia
$59.10$44.00
North Carolina
$58.89$42.69
Wisconsin
$58.76$42.12
Kentucky
$58.40$42.96
Indiana
$58.38$42.28
Oklahoma
$58.18$42.67
Idaho
$58.17$42.19
Tennessee
$58.03$42.25
Nebraska
$58.02$41.99
Iowa
$57.86$41.97
Kansas
$57.83$42.13
Mississippi
$57.27$42.32
Alabama
$57.23$42.03
Arkansas
$56.70$41.78

Billed by 1 specialties

Commercial rates for 99425

Medicare is the floor, not the market. See what UHC, Aetna, Cigna and BCBS actually pay — down to the TIN.

See negotiated rates