# CPT 99426

> Medicare paid $63.33 for CPT 99426 in the office (non-facility) setting and $50.53 in a facility under the Q2 2022 Physician Fee Schedule, effective April 2022. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment.

## What it is

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.

## Selected release

- Release: Q2 2022 (2022 B)
- Effective: April 1 – June 30, 2022
- Status indicator: A
- Office (non-facility) national allowed amount: $63.33
- Facility national allowed amount: $50.53
- Sequestration: not applied

## RVUs and formula

- Work RVU: 1.00
- Office (non-facility) practice expense RVU: 0.75
- Facility practice expense RVU: 0.38
- Malpractice RVU: 0.08
- Conversion factor: 34.6062
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q2 2022)
- CMS file: https://www.cms.gov/files/zip/rvu22b.zip
- Parsed file: PPRRVU22_APR.csv, row 17,566
- Canonical page: https://localishealth.com/cpt/99426/2022/A
- Release-specific citation URL: https://localishealth.com/cpt/99426/2022/B
- Last significant update: 2026-08-04T03:11:36+00:00