There are four PCM CPT Codes, based on condition specific care management and patient monitoring activities.
HealthArc’s PCM platform is designed to improve care coordination, reduce hospitalizations and emergency room visits, and provide ongoing and regular non-face-to-face clinical care management for chronic patients.
Brief Overview of the Principal Care Management (PCM) CPT Codes for 2026 and 2027
CPT 99424 – Physician/Qualified Healthcare Professional, First 30 Minutes
- Designed to bill for the first 30 minutes per calendar month of PCM services provided by a physician or qualified healthcare professional (QHP).
- Includes activities such as developing, monitoring, and revising a care plan; specialist communication; medication management; and reviewing patient status at the monthly visit with appropriate ongoing documentation.
- Must be utilized for patient-specific and condition-specific management.
CPT 99425 – Each Additional 30 Minutes (Physician/QHP)
- Designed to bill the physician or QHP for each additional 30 minutes of PCM services in a given calendar month.
- The add-on code must be billed in association with CPT code 99424.
- There is no limit to the use of this code; however, documentation of the billed time must substantiate the coding.
CPT 99426 – Clinical Staff Time Under a Physician or QHP, First 30 Minutes
- Used for the first 30 minutes of PCM services provided by clinical staff under the direct supervision of a physician or QHP.
- Time must be spent on activities such as care plan revisions or updates, patient communication, coordinated services, or medication adherence.
- Time may be spent under general supervision, providing practices with greater flexibility.
CPT 99427 – Each Additional 30 Minutes (Clinical Staff Time)
- This is an add-on code for each additional 30 minutes of clinical staff time spent in a month.
- This code is billed in conjunction with CPT 99426 when additional clinical staff time is provided.
Who Can Bill for PCM?
Both the PCM CPT codes can be reported and billed by:
- Physicians (MD/DO)
- Nurse Practitioners (NPs)
- Physician Assistants (PAs)
- Clinical Nurse Specialists
- Certified Nurse Midwives
Clinical staff (RN, MA, etc.) may provide services under the physician’s or QHP’s supervision using codes 99426/99427.
Medicare Reimbursement for PCM Services in 2026 and 2027
Medicare national non-facility rates for the PCM codes in 2026 and 2027:
| Code | What it covers | 2026 | 2027 (from Jan 1, 2027, CY2027 final rule) |
|---|---|---|---|
| 99424 | PCM, physician/QHP, first 30 minutes | $87.51 | $83.86 |
| 99425 | PCM, physician/QHP, each additional 30 minutes | $61.46 | $59.71 |
| 99426 | PCM, clinical staff, first 30 minutes | $67.80 | $66.56 |
| 99427 | PCM, clinical staff, each additional 30 minutes | $54.11 | $53.84 |
Source: CMS Medicare Physician Fee Schedule, national non-facility amounts (total RVUs times the conversion factor). 2026: RVU26D, October 2026 file, $33.4009 conversion factor. 2027: CY2027 final rule (CMS-1848-F), Addendum B, $32.6286 conversion factor. Your payment is adjusted for your locality and setting, and commercial payers set their own rates. What changed in the 2027 final rule.
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- Automated PCM time tracking & billing
- 99424, 99425, 99426 & 99427 tracked for you
- Two-way EHR integration
- Managed care team, or your own
- Runs alongside CCM and RPM on one platform
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