{
    "code": "99426",
    "coding_system": "CPT",
    "canonical_url": "https://localishealth.com/cpt/99426/2022/A",
    "release_specific_url": "https://localishealth.com/cpt/99426/2022/A",
    "description": "Month-by-month care coordination organised around one serious chronic condition rather than a whole panel of them, carried out by clinical staff working under a physician or other qualified clinician. The work happens between visits: building and maintaining a disease-specific care plan, reviewing medications, checking on the patient, and coordinating with the specialists and services involved. This code covers the first block of about thirty minutes of that staff time in a calendar month; further time is reported with the add-on that follows it.",
    "answer": {
        "question": "How much did Medicare pay for CPT 99426 in Q1 2022?",
        "text": "Medicare paid $63.33 for CPT 99426 in the office (non-facility) setting and $50.53 in a facility under the Q1 2022 Physician Fee Schedule, effective January 2022. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment."
    },
    "release": {
        "schedule": "pfs",
        "year": 2022,
        "quarter": "A",
        "label": "Q1 2022",
        "effective": "January 1 – March 31, 2022",
        "revision": 1
    },
    "status": {
        "code": "A",
        "non_facility_payable": true,
        "facility_payable": true
    },
    "national_rates_usd": {
        "office_non_facility": 63.33,
        "facility": 50.53,
        "sequestration_applied": false,
        "gpci": 1
    },
    "rvus": {
        "work": 1,
        "practice_expense_non_facility": 0.75,
        "practice_expense_facility": 0.38,
        "malpractice": 0.08
    },
    "formula": "(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor",
    "conversion_factor": 34.6062,
    "source": {
        "label": "Physician relative value file (Q1 2022)",
        "cms_url": "https://www.cms.gov/files/zip/rvu22a.zip",
        "local_source_url": "https://localishealth.com/sources/physician-fee-schedule/2022/A",
        "file": "PPRRVU22_JAN.csv",
        "row": 17536,
        "sha256": "10258dd1f6966657ef18c0f2c85ff446c9d799406974c4b536139a327c43799e"
    },
    "modified_at": "2026-08-04T03:11:16+00:00"
}