2026 Principal Care Management CPT Codes and Reimbursement

CMS has released the updated CPT codes for Principal Care Management (PCM) for 2026. Principal Care Management is a Medicare program for managing one chronic condition. In this video, we dive deep into all the information needed to properly code and bill for this program.

Make sure to download a reference guide for the PCM CPT codes.

In this year’s Final Rule, there were no major changes to the PCM program, but there is some very exciting news around reimbursement increases! With these increased rates, CMS is encouraging increased utilization of the program and incentivizing groups to grow or start a PCM program.

Remember that the codes are based on national averages, which may vary in your area. Visit the Physician Fee Schedule website for the exact current rates based on your location.

PCM CPT codes are based on who is providing services, either for provider time or for clinical time.

Let’s start with the provider codes.

PCM Provider Codes

First is CPT code is 99424 for 30 minutes of provider, non-face-to-face PCM services. The current national average reimbursement is $88, which is up nearly 7 dollars from last year.

Next is the add-on code, 99425 for 30 additional minutes of non-face-to-face provider time. It has a national average reimbursement rate of $61, which is up nearly 3 dollars from last year. There is no limit on how many times this code can be billed, so you’d bill it at 60 minutes, 90 minutes, and 120 plus minutes.

PCM Clinical Codes

The first one is 99426. It’s for 30 minutes of non-face-to-face time performed by a clinician. This could be a certified resource or higher who is not a provider at your practice. The national average reimbursement is about $68, which is up about 6 dollars from last year.

Next, the add-on code for PCM clinician time is 99427. It's for an additional 30 minutes of clinician time. It has a national average reimbursement of about $54, which is up almost 4 dollars from last year.  There is also no limit on how many times this code can be billed, so you’d bill it at 60 minutes, 90 minutes, and 120 plus minutes.

That’s it for the 2026 CPT codes for Principal Care Management. With the reimbursement increases this year, there’s a great opportunity to grow your program and offer this valuable service to more patients. If you need help in starting or growing your PCM program, reach out to us and we’d be happy to help.