# CPT 99425: Principal care management services, each additional 30 minutes per month, physician or QHP (add-on)

Medicare 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.

Web page: https://www.med-reveal.com/rates/99425-cpt-fee-schedule
Section: Evaluation and Management
Billed by: Evaluation

## Medicare rates

| | Amount |
| --- | --- |
| National non-facility | $61.46 |
| National facility | $44.09 |
| Conversion factor | 33.4009 |
| Release | 2026 Q4 (effective 2026-10-01) |

## By state

| State | Non-facility | Facility |
| --- | --- | --- |
| Alaska | $78.78 | $60.28 |
| District of Columbia | $68.10 | $47.64 |
| New York | $66.85 | $47.48 |
| New Jersey | $66.62 | $47.06 |
| California | $66.30 | $45.74 |
| 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 | $62.46 | $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 | $60.79 | $44.22 |
| 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 | $42.85 |
| Louisiana | $59.33 | $43.47 |
| Missouri | $59.31 | $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 |

## Related codes

- 99424: Principal care management services, first 30 minutes per month, physician or QHP — https://www.med-reveal.com/rates/99424-cpt-fee-schedule
- 99426: Principal care management services, first 30 minutes per month, clinical staff — https://www.med-reveal.com/rates/99426-cpt-fee-schedule
- 99427: Principal care management services, each additional 30 minutes per month, clinical staff (add-on) — https://www.med-reveal.com/rates/99427-cpt-fee-schedule
- 99439: Chronic care management services, non-complex, each additional 20 minutes per month (add-on) — https://www.med-reveal.com/rates/99439-cpt-fee-schedule
- 99484: General behavioral health integration care management, first 20 minutes per month — https://www.med-reveal.com/rates/99484-cpt-fee-schedule
- 99487: Complex chronic care management services, first 60 minutes per month — https://www.med-reveal.com/rates/99487-cpt-fee-schedule
- 99489: Complex chronic care management services, each additional 30 minutes per month (add-on) — https://www.med-reveal.com/rates/99489-cpt-fee-schedule
- 99490: Chronic care management services, non-complex, first 20 minutes per month — https://www.med-reveal.com/rates/99490-cpt-fee-schedule

Commercial negotiated rates for 99425 by payer and state: https://www.med-reveal.com/solutions/rate-benchmarking

## Sources

- CMS Medicare fee schedules (2026 Q4): https://www.cms.gov/medicare/payment/fee-schedules