99426 Prin care management staff first 30
Also known as: principal care management staff, CCM staff, chronic care management clinical
Principal care management services for a single high-risk disease or chronic condition, for a patient 18 years of age or older, by clinical staff, supervised by a physician or other qualified health professional; first 30 minutes of clinical staff time in a calendar month.
In Plain Language
Care coordination by clinical staff; Staff-led chronic disease management
Clinical Context
Used for principal care management services provided by clinical staff under physician supervision, including care coordination and disease-specific management for patients with high-risk chronic conditions.
RVU Breakdown
| Work RVU | 1.00 |
| Total RVU | 1.00 |
Est. Medicare Payment
National estimate based on 2026 CMS PFS Conversion Factor ($33.40). Actual payment varies by locality (GPCI adjustment).
Billing & Documentation
E&M codes require documentation of medical decision-making (MDM) complexity or total time spent on the encounter. For 2026, time-based coding includes all physician time on the date of the encounter.
How This Code Compares
With a work RVU of 1.00, this code ranks in the 30th percentile among Evaluation & Management codes — 1.5x below the median (1.54). The highest wRVU in this category is 18.46.
Specialties
Frequently Asked Questions
What is CPT code 99426?
CPT 99426 (Prin care management staff first 30) is a Evaluation & Management code. Principal care management services for a single high-risk disease or chronic condition, for a patient 18 years of age or older, by clinical staff, supervised by a physician or other qualified health professional; first 30 minutes of clinical staff time in a calendar month.
Who uses CPT code 99426?
CPT 99426 is used by Primary Care, All Specialties. Used for principal care management services provided by clinical staff under physician supervision, including care coordination and disease-specific management for patients with high-risk chronic conditions.
When is CPT 99426 used?
Used for principal care management services provided by clinical staff under physician supervision, including care coordination and disease-specific management for patients with high-risk chronic conditions.
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CPT® is a registered trademark of the American Medical Association. Data sourced from CMS Physician Fee Schedule RVU26A. Descriptions, synonyms, and clinical context are original content by RVU Edge.