CPT 99427 is an add-on billing code used to report each additional 30 minutes of Principal Care Management services delivered by clinical staff under the supervision of a physician or QHP. It must be billed with CPT 99426.

When can you bill CPT 99427?

CPT 99427 can be billed when more than 60 minutes of clinical staff time is spent providing PCM services in a calendar month. It must be reported in conjunction with CPT 99426.

Can CPT 99427 be billed without CPT 99426?

No. CPT 99427 is an add-on code and may only be billed when CPT 99426 has also been reported for the same calendar month.

What documentation is required for CPT 99427?

You must document the total time spent beyond 30 minutes, the specific PCM services delivered by clinical staff, and the provider's supervision. All time must be non-overlapping and disease-specific.

Can CPT 99427 be billed with other care management codes?

No. CPT 99427 may not be billed in the same month as CCM, complex CCM, provider PCM codes, transitional care management, or behavioral health integration codes.

CPT 99427
Description, Billing Rules, and Use Cases

CPT 99427 is an add-on code used to report each additional 30-minute block of Principal Care Management (PCM) services provided by clinical staff, under the supervision of a physician or other qualified healthcare professional.

This code must be reported in conjunction with CPT 99426, which covers the first 30 minutes.

CPT 99427 is used when PCM services exceed 60 minutes in a calendar month and may be billed up to twice per month if time thresholds are met

What is CPT Code 99427?

CPT 99427 is used to report each additional 30 minutes of care management services delivered by clinical staff for a patient with a single high-risk chronic condition. These services are directed by a physician or QHP and are billed in addition to CPT 99426, which must always be reported first.

To qualify:

The patient must have a chronic condition expected to last at least 3 months

The condition must pose a serious risk of hospitalization, functional decline, or death

A disease-specific care plan must be implemented, monitored, or revised during the billing period

Clinical staff must provide care under provider supervision, and total time for the month must exceed 60 minutes to report this code

CPT 99427 may be billed a maximum of two times per calendar month, and only alongside CPT 99426. It may not be used on its own or with overlapping codes such as CCM, complex CCM, or provider PCM codes.

CPT 99427 Billing Requirements and Eligibility

CPT 99427 is an add-on billing code used to report each additional 30-minute block of Principal Care Management (PCM) services provided by clinical staff under the direction of a physician or qualified healthcare professional (QHP). It is only used in conjunction with CPT 99426, which covers the first 30 minutes.

Patient Eligibility Criteria

The patient has one serious chronic condition that:
- Is expected to last at least 3 months
- Places the patient at significant risk of hospitalization, exacerbation, or functional decline
- Requires frequent medication adjustments or active coordination of care
The condition is the primary focus of care during the billing month

Care Plan Requirements

A disease-specific care plan must be:
- Established, implemented, revised, or monitored during the month
- Documented in the patient’s chart
- Shared with the patient or caregiver as appropriate
The plan must include clearly defined goals, treatment activities, and outcomes tracking

Provider Requirements

The billing provider must be a physician, nurse practitioner, or physician assistant
PCM services must be delivered by clinical staff under their supervision
CPT 99427 may be billed only if CPT 99426 has already been reported for that month

Service Requirements

A minimum of 60 minutes of total clinical staff time must be met before billing 99427
- The first 30 minutes must be billed with CPT 99426
- Each 99427 unit represents an additional 30-minute block
Time must be:
- Non-face-to-face
- Clearly documented and distinct from any other care management services
- Directed by a supervising provider who actively oversees the care plan
99427 may be billed up to two times per calendar month (i.e., maximum of 99426 + 99427 ×2)

CPT 99427 Billing Documentation Checklist

To compliantly bill CPT 99427, ensure that your clinical documentation includes the following elements:

Confirmation that CPT 99426 has already been billed for the same patient and month
- CPT 99427 is an add-on code and may not be used independently
A cumulative record of at least 60 minutes of Principal Care Management time delivered by clinical staff
- Each 99427 unit requires a full additional 30-minute block beyond the initial 30 minutes
Time logs that include:
- Dates, activities performed, and start/stop or total time recorded
- Distinct separation from any other time-based care management services
A disease-specific care plan that was:
- Created, revised, or actively monitored during the billing period
- Tailored to the targeted condition
- Documented in the EHR and, if applicable, shared with the patient or caregiver
Activity documentation for each additional 30-minute increment, including:
- Care coordination across specialties
- Patient or caregiver education
- Community service referral coordination
- Monitoring treatment adherence or clinical parameters
A note verifying that time was:
- Directed by the billing provider
- Non-face-to-face
- Not overlapping with codes such as:
  - 99490, 99491 (CCM)
  - 99487, 99489 (complex CCM)
  - 99424, 99425 (provider PCM)
  - TCM or behavioral integration codes (99495–99496, 99484, etc.)

CPT 99427 Time Thresholds and Code Combinations

CPT 99427 is used to report each additional 30-minute block of Principal Care Management (PCM) services delivered by clinical staff, under the supervision of a physician or qualified healthcare professional. This code is billed in addition to CPT 99426, which covers the first 30 minutes. CPT 99427 may be reported up to twice per calendar month, provided that additional time thresholds are clearly met and documented.

Use the chart below to determine the correct code(s) based on total time:

Time-based billing table for CPT 99427. Shows when to report each additional 30-minute block of clinical staff–delivered PCM services after CPT 99426 has been billed.

Important to Note:

CPT 99427 is an add-on code and may only be billed with CPT 99426. You must meet a minimum of 60 total minutes of clinical staff time before reporting 99427. Each additional unit must represent a distinct 30-minute block of non-overlapping, provider-directed care.

CPT 99427 may not be billed in the same month as staff-based CCM (99490, 99439), provider PCM (99424–99425), or complex care management codes (99487–99489).

When to Use CPT 99427:
Common Scenarios and Use Cases

CPT 99427 should be used when clinical staff provide more than 60 minutes of Principal Care Management (PCM) services in a calendar month under the supervision of a physician or QHP. This code is only billed in addition to CPT 99426 and reflects care focused on a single chronic condition.

Here are examples of how CPT 99427 is used in practice:

Advanced Asthma Case Requiring Multiple Follow-Ups
Clinical staff allocates time to:
- Coordinate with pulmonology for medication adjustment
- Provide repeated caregiver education
- Monitor adherence and adjust care plan twice during the month
  Total time: 75 minutes
  Billing: 99426 + 99427

CHF Patient Requiring Ongoing Home Monitoring
Staff under NP supervision:
- Manage communication with home health team
- Log and review symptom reports twice weekly
- Assist with complex medication titration and dietary compliance
- Total time: 95 minutes
  Billing: 99426 + 99427 ×2

High-Risk Diabetic With Social Support Challenges
Clinical Staff:
- Coordinate social work services for housing and food access
- Review glucose logs and share weekly insights with primary care provider
- Provide structured self-management coaching
  Total provider time: 120 minutes
  Billing: 99426 + 99427 x 2

Common CPT 99427 Billing Mistakes
(and How to Avoid Them)

❌ Billing CPT 99427 Without 99426
CPT 99427 is an add-on code and cannot be reported by itself. It must always be billed in the same calendar month and claim as CPT 99426.
❌ Reporting Time Below 60 Minute
CPT 99427 may only be billed once the total clinical staff time reaches at least 60 minutes. If only 30–59 minutes are documented, report CPT 99426 only.
❌ Billing Without a Disease-Specific Care Plan
A documented care plan tailored to the specific condition is required. Generic templates or general wellness plans do not satisfy this requirement.
❌ Using 99427 for Provider Time
- Only clinical staff time may be counted toward 99427. If the time is personally delivered by a physician or QHP, provider PCM codes (99424/99425) must be used instead.
❌ Overlapping With Other PCM or CCM Codes
- Do not bill CPT 99427 in the same calendar month as:
  - 99490 or 99491 (Chronic Care Management)
  - 99424 or 99425 (provider PCM)
  - 99487 or 99489 (complex CCM)
  - 99495–99496 or 99484 (TCM/BHI)
- All time must be distinct and focused solely on the PCM-qualified condition.
❌ Lack of Documentation for Additional Time
- You must document:
  - The total time spent by clinical staff beyond the first 30 minutes
  - Specific care coordination or education activities performed
  - The provider’s supervision and direction of services
  - That services were delivered non-face-to-face and in support of a disease-specific care plan

CPT 99427 Description, Billing Rules, and Use Cases