# CPT 99426

> Medicare paid $61.91 for CPT 99426 in the office (non-facility) setting and $48.93 in a facility under the Q4 2024 Physician Fee Schedule, effective October 2024. These are the national allowed amounts before the ~2% sequestration cut and before locality (GPCI) adjustment. This price has been unchanged since Q1 2024, when it increased 0.9%.

## 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: Q4 2024 (2024 D)
- Effective: October 1 – December 31, 2024
- Status indicator: A
- Office (non-facility) national allowed amount: $61.91
- Facility national allowed amount: $48.93
- Sequestration: not applied

## RVUs and formula

- Work RVU: 1.00
- Office (non-facility) practice expense RVU: 0.78
- Facility practice expense RVU: 0.39
- Malpractice RVU: 0.08
- Conversion factor: 33.2875
- Formula: `(work_rvu × work_gpci + pe_rvu × pe_gpci + mp_rvu × mp_gpci) × conversion_factor`

## Source and citation

- Source: Physician relative value file (Q4 2024)
- CMS file: https://www.cms.gov/files/zip/rvu24d.zip
- Parsed file: PPRRVU24_OCT.csv, row 18,631
- Canonical page: https://localishealth.com/cpt/99426/2024/A
- Release-specific citation URL: https://localishealth.com/cpt/99426/2024/D
- Last significant update: 2026-08-04T03:14:25+00:00