CPT 99424 is a billing code for the first 30 minutes of non-face-to-face Principal Care Management services personally provided by a physician or QHP. It applies to a single chronic condition and cannot be delegated to clinical staff.

When can you bill CPT 99424?

CPT 99424 can be billed when a provider delivers at least 30 minutes of non-face-to-face care management for a patient with one serious chronic condition in a calendar month.

What is the difference between CPT 99424 and 99426?

CPT 99424 is for provider-delivered PCM services. CPT 99426 is for PCM services performed by clinical staff under supervision. They cannot be billed together.

Can CPT 99424 be billed with 99425?

Yes. CPT 99424 covers the first 30 minutes of provider time. CPT 99425 is used to report each additional 30-minute block of provider-delivered PCM services in the same calendar month.

What documentation is required for CPT 99424?

You must document the provider’s total time, the specific care management activities performed, the condition treated, and a disease-specific care plan. Time must be non-face-to-face and not overlap with other care management codes.

CPT 99424
Description, Billing Rules, and Use Cases

CPT 99424 is used to bill for Principal Care Management (PCM) services that are personally delivered by a physician or other qualified healthcare professional (QHP). This code covers the first 30 minutes of non-face-to-face care management in a calendar month for a patient with a single high-risk chronic condition.

CPT 99424 applies only when the provider—not clinical staff—delivers the service directly and coordinates a disease-specific care plan.

What is CPT Code 99424?

CPT 99424 is a time-based code that allows physicians and other qualified healthcare professionals (QHPs) to report the first 30 minutes of non-face-to-face Principal Care Management for patients with a single complex chronic condition. These services must be provided personally by the provider, not delegated to clinical staff.

To use CPT 99424, all of the following must apply:

The patient has one chronic condition expected to last at least 3 months

The condition places the patient at significant risk of hospitalization, functional decline, or death

A disease-specific care plan is actively managed, implemented, or revised

Services involve moderate or high complexity medical decision-making

A minimum of 30 minutes of direct, non-face-to-face provider time is documented within the calendar month

If the total provider time exceeds 60 minutes, use CPT 99425 to bill for each additional 30-minute block of time.

CPT 99424 Billing Requirements and Eligibility

CPT 99424 is used to bill for Principal Care Management (PCM) services that are personally provided by a physician or qualified healthcare professional (QHP). This code applies to the first 30 minutes of non-face-to-face care coordination, monitoring, and education for a patient with a single high-risk chronic condition.

Patient Eligibility Criteria

The patient has one serious chronic condition that:
- Is expected to last at least 3 months
- Poses a significant risk of hospitalization, exacerbation, or functional decline
- Requires disease-specific care coordination, frequent medication adjustments, or intensive monitoring
The chronic condition must be the primary focus of care for the month

Care Plan Requirements

A comprehensive care plan must be:
- Established, revised, or implemented during the billing month
- Tailored specifically to the patient’s diagnosed condition
- Documented in the medical record
- Shared with the patient and/or caregiver, as appropriate
The care plan must include goals, interventions, clinical parameters, and outcome tracking

Provider Requirements

The services must be delivered personally by the billing provider (physician, NP, or PA)
CPT 99424 cannot be billed using clinical staff time
The provider must oversee and direct the care plan throughout the billing period

Service Requirements

At least 30 minutes of non-face-to-face provider time must be documented within the calendar month
Time must reflect activities such as:
- Medication management or titration
- Communication with specialists or external care teams
- Education or coaching provided directly to the patient or caregiver
- Monitoring of disease-specific progress or treatment plan adherence
Services must be:
- Non-face-to-face (i.e., outside of an E/M office visit)
- Distinct from time billed under other care management or transition codes
- Directed by the same provider responsible for the patient’s PCM oversight

CPT 99424 Billing Documentation Checklist

To bill CPT 99424 compliantly, ensure the following are clearly documented in the medical record:

A minimum of 30 minutes of non-face-to-face care personally delivered by the physician or QHP
- Include detailed time logs with dates, activities performed, and total time recorded
- Do not include clinical staff time
Evidence of a disease-specific care plan that was:
- Created, updated, implemented, or actively managed during the billing period
- Focused on the single chronic condition being treated
- Documented in the EHR and, if applicable, shared with the patient or caregiver
Documentation that the condition:
- Is expected to last at least 3 months
- Poses significant risk of serious clinical outcomes or death
- Was the primary focus of care during the calendar month
Clear provider attribution confirming that the billing provider:
- Personally performed the documented services
- Directed the care plan and led all management activities for the patient
- Made moderate or high complexity medical decisions during the billing period
Confirmation that billed time:
- Was non-face-to-face
- Did not overlap with other services billed (e.g., 99426–99427, 99490–99491, 99487–99489, TCM/BHI codes)

CPT 99424 Time Thresholds and Code Combinations

CPT 99424 is used to report the first 30 minutes of Principal Care Management (PCM) services personally delivered by a physician or qualified healthcare professional (QHP). If more time is spent within the same calendar month, you may report CPT 99425 for each additional 30-minute block.

Use the table below to determine the correct code(s) to report based on total provider time:

Time-based billing table for CPT 99424. Used to report the first 30 minutes of provider-delivered PCM services. CPT 99425 is added for each additional 30-minute block of time.

Important to Note:

Reminder: CPT 99424 may only be used to report provider-delivered PCM services. Clinical staff time may not be counted.
If total provider time exceeds 60 minutes, report CPT 99425 for each additional 30-minute block. Time must be:

Personally performed by the billing provider
Non-face-to-face
Focused on a single high-risk chronic condition
Documented separately from other care management or E/M services

When to Use CPT 99424:
Common Scenarios and Use Cases

CPT 99424 should be used when a physician or qualified healthcare professional (QHP) spends at least 30 minutes in a calendar month providing non-face-to-face care management for a patient with a single serious chronic condition. This code is reserved for provider-delivered time and must reflect work beyond a typical office visit.

Here are examples of how CPT 99424 is used in practice:

Direct Oversight of Uncontrolled Epilepsy
A neurologist:
- Reviews EEG and imaging results
- Revises medication regimen and risk counseling plan
- Communicates with the patient and caregiver to reinforce adherence strategies
  Total time: 35 minutes
  Billing: 99424

Oncology Management Between Treatments
An oncologist:
- Coordinates radiation follow-up
- Adjusts oral chemotherapy and pre-medications
- Communicates with both palliative care and pharmacy
  Total time: 55 minutes
  Billing: 99424

Complex Diabetes Management in a Rural Patient
A Family Medicine Physician:
- Reviews home glucose logs and adjusts insulin plan
- Coordinates supplies with DME and pharmacy
- Works with case management for food assistance and transportation
  Total provider time: 70 minutes
  Billing: 99424 + 99495

Common CPT 99424 Billing Mistakes
(and How to Avoid Them)

Ensure clean claims and avoid compliance issues by watching for these frequent errors when billing CPT 99424:

❌ Billing CPT 99424 Without 30 Minutes of Provider Time
You must document at least 30 minutes of non-face-to-face care personally delivered by a physician or QHP. Anything less is not billable under this code.
❌ Using 99424 for Clinical Staff Time
Only the billing provider’s time counts. Time spent by clinical staff—RNs, MAs, or care coordinators—must not be included in 99424 reporting. If staff are delivering the service, use CPT 99426 instead.
❌ Managing More Than One Condition Under 99424
CPT 99424 is intended for a single serious chronic condition. If multiple conditions are managed, this must be documented clearly—or consider using CCM codes.
❌ Overlapping With Other Time-Based Codes
- Do not bill CPT 99424 in the same calendar month as:
  - 99426 or 99427 (staff PCM)
  - 99490 or 99491 (CCM)
  - 99487 or 99489 (complex CCM)
  - 99495–99496 or 99484 (TCM/BHI)
- All time must be distinct, disease-specific, and documented separately.
❌ Incomplete Documentation of Care Activities
- You must include:
  - Specific dates and total time spent
  - Detailed descriptions of care coordination, monitoring, or education
  - A copy or reference to the care plan being implemented or adjusted
  - A statement confirming that the services were delivered non-face-to-face

CPT 99424 Description, Billing Rules, and Use Cases