CPT 99424
Global XXX ActivePrin care mgmt phys 1st 30
CPT 99424 Billing & Documentation Guide
CPT code 99424 (Prin care mgmt phys 1st 30) is classified under E/M with a global period indicator of XXX. The 2026 Medicare Physician Fee Schedule assigns a work RVU of 1.45, a non-facility practice expense RVU of 1.06, and a malpractice RVU of 0.11, a total non-facility RVU of 2.62 and facility RVU of 1.94. With the current conversion factor of $33.4009, the national average non-facility reimbursement is approximately $89.52, though rates vary from $80.74 to $112.38 based on MAC locality and Geographic Practice Cost Indices (GPCIs).
When billing 99424, ensure documentation supports medical necessity and the specific components required for the code's level of service. For E/M codes, document MDM (medical decision-making) elements: problems addressed, data reviewed, and risk. For procedural codes, document the indication, technique, and any complications. Always verify NCCI edits before bundling 99424 with related codes; this code has 10 PTP bundling relationships on file (see table below).
Payment Status & Global Period
Active code (paid under MPFS)
No global period (E/M and other non-procedural services)
MUE Limit (Medically Unlikely Edits)
Submitting more than 1 units of 99424 for the same patient on the same date triggers automatic line denial unless an appropriate modifier and supporting documentation justify the higher quantity.
RVU Breakdown, CPT 99424
| Component | Non-Facility | Facility |
|---|---|---|
| Work RVU | 1.45 | 1.45 |
| Practice Expense RVU | 1.06 | 0.38 |
| Malpractice RVU | 0.11 | 0.11 |
| Total RVU | 2.62 | 1.94 |
| Conversion Factor | $33.4009 | |
2026 Medicare Reimbursement by State, CPT 99424
State-level averages across all MAC localities. Non-facility rates typically apply to office-based services; facility rates apply to hospital outpatient / inpatient.
| State | Non-Facility | Facility | Range (Non-Fac) | Localities |
|---|---|---|---|---|
| California | $94.05 | $67.18 | $90.03 - $106.78 | 29 |
| Florida | $91.11 | $68.32 | $87.8 - $94.58 | 3 |
| Georgia | $86.68 | $65.01 | $84.39 - $88.96 | 2 |
| Illinois | $89.83 | $67.89 | $86.5 - $92.78 | 4 |
| Michigan | $86.85 | $65.52 | $84.9 - $88.79 | 2 |
| North Carolina | $83.81 | $62.62 | $83.81 - $83.81 | 1 |
| New York | $95.22 | $69.88 | $84.65 - $100.45 | 5 |
| Ohio | $84.46 | $63.72 | $84.46 - $84.46 | 1 |
| Pennsylvania | $87.48 | $65.23 | $84.41 - $90.54 | 2 |
| Texas | $86.97 | $64.6 | $84.06 - $89.24 | 8 |
Source: CMS PFSRVU 2026 · Updated 2026-04-01. Full locality-level detail available for all 53 states, contact us for custom reports.
NCCI Bundling Edits, CPT 99424
Procedure-to-procedure (PTP) edits. If you bill any of these codes with 99424 on the same date of service, review the modifier indicator and payer policy before submission.
| Partner Code | Relationship | Modifier Allowed | Rationale |
|---|---|---|---|
| 0362T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0373T | Column 1 (primary), can be billed with modifier | Yes | Misuse of Column Two code with Column One code |
| 0469T | Column 1 (primary), can be billed with modifier | No | Misuse of Column Two code with Column One code |
| 0488T | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36591 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 36592 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94002 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94003 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94004 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
| 94660 | Column 1 (primary), can be billed with modifier | No | CPT Manual or CMS manual coding instruction |
Frequently Asked Questions, CPT 99424
What does CPT code 99424 mean? +
CPT code 99424 represents: Prin care mgmt phys 1st 30. It's in the E/M category with a global period of XXX.
What is the Medicare reimbursement for CPT 99424? +
The 2026 Medicare national average non-facility payment for CPT 99424 is $89.52. Rates range from $80.74 to $112.38 across 53 states depending on MAC locality and GPCIs.
What modifiers can I use with CPT 99424? +
E/M codes commonly use modifier 25 (significant separately identifiable E/M on same day as a procedure), 57 (decision for major surgery), 24 (unrelated E/M during global period), 95 (synchronous audio+video telehealth), 93 (audio-only telehealth), and AI (principal physician of record on admission). Surgical modifiers like 50, 51, 59 do not apply to E/M.
What bundling edits apply to CPT 99424? +
This code has 10 NCCI PTP bundling relationships. See the NCCI Bundling section below for full list.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on June 1, 2026.
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