Rate Benchmarking
Compare your rates with similar providers.
Select a published rate, define comparable providers, and see where that rate falls in your market.
See a sample rate comparisonCPT 99424 Fee Schedule
Last Verified: October 2026
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
Prin Care Mgmt Phys 1st 30, Principal Care Management Services For A Single High Risk Disease With The Following Required Elements One Complex Chronic Condition Expected To Last At Least 3 Months And That Places The Patient At Significant Risk Of Hospitalization Acute Exacerbation Decompensation Functional Decline Or Death The Condition Requires Development Monitoring Or Revision Of Disease Specific Care Plan The Condition Requires Frequent Adjustments In The Medication Regimen And Or The Management Of The Condition Is Unusually Complex Due To Comorbidities Ongoing Communication And Care Coordination Between Relevant Practitioners Furnishing Care First 30 Minutes Provided Personally By A Physician Or Other Qualified Health Care Professional Per Calendar Month
| Key Fact | Detail |
|---|---|
| Service Type | Evaluation and Management Preventive Medicine Services |
| Common Place of Service | 11 - Office 99 - Other POS |
| Common Modifiers | 95 - Telemedicine - audio and video GV - Attending physician is not employed or paid under agreement by the patient's Hospice provider |
| Complexity Level | Low |
| Medicare Fee Schedule | $87.51 national non-facility rate (2026) · View Medicare rates for 99424 |
| Medicaid Fee Schedule | $71.58 median of the 8 states in the free preview · View Medicaid rates for 99424 |
National average reimbursement for CPT 99424 by major payers:
$99.96
$107.04
$91.08
$138.65
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 99424.
CPT 99424
5 of 25 sample ratesHigher to lower in this preview
Grace Gombolay
$286.76Published rateJinal Shah
Methodist Hospital
$131.42Published rateAna Macias
Heywood Medical Group Inc
$97.61Published rateQingguo Tao
Qingguo Tao Md PA
$78.27Published rateYatin Patil
Apogee Medical Group Of New Jersey PA
$49.97Published rate
Get a free rate benchmark for your specialty.
Choose your state and specialty to build a report from payer-published rates.
Use market rates to prepare your payer proposal.
Payer Contract Negotiation
Draft a fee schedule renegotiation letter.
Use your fee schedule and market benchmarks to set target rates and draft a letter for your payer.
See a sample payer proposalCPT 99424 vs. Other Preventive Medicine Services Codes
The CPT 99424 code is part of the Evaluation and Management services used for Preventive Medicine Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The CPT 99424 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| Code | Complexity | Description |
|---|---|---|
| 99421-CPT | Low | Online Digital Evaluation And, Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days 5-10 Minutes |
| 99424-CPT | Low | Prin Care Mgmt Phys 1st 30, Principal Care Management Services For A Single High Risk Disease With The Following Required Elements One Complex Chronic Condition Expected To Last At Least 3 Months And That Places The Patient At Significant Risk Of Hospitalization Acute Exacerbation Decompensation Functional Decline Or Death The Condition Requires Development Monitoring Or Revision Of Disease Specific Care Plan The Condition Requires Frequent Adjustments In The Medication Regimen And Or The Management Of The Condition Is Unusually Complex Due To Comorbidities Ongoing Communication And Care Coordination Between Relevant Practitioners Furnishing Care First 30 Minutes Provided Personally By A Physician Or Other Qualified Health Care Professional Per Calendar Month |
| 99425-CPT | Low | Prin Care Mgmt Phys Ea Addl, Principal Care Management Services For A Single High Risk Disease With The Following Required Elements One Complex Chronic Condition Expected To Last At Least 3 Months And That Places The Patient At Significant Risk Of Hospitalization Acute Exacerbation Decompensation Functional Decline Or Death The Condition Requires Development Monitoring Or Revision Of Disease Specific Care Plan The Condition Requires Frequent Adjustments In The Medication Regimen And Or The Management Of The Condition Is Unusually Complex Due To Comorbidities Ongoing Communication And Care Coordination Between Relevant Practitioners Furnishing Care Each Additional 30 Minutes Provided Personally By A Physician Or Other Qualified Health Care Professional Per Calendar Month List Separately In Addition To Code For Primary Procedure |
| 99426-CPT | Low | Prin Care Mgmt Staff 1st 30, Principal Care Management Services For A Single High Risk Disease With The Following Required Elements One Complex Chronic Condition Expected To Last At Least 3 Months And That Places The Patient At Significant Risk Of Hospitalization Acute Exacerbation Decompensation Functional Decline Or Death The Condition Requires Development Monitoring Or Revision Of Disease Specific Care Plan The Condition Requires Frequent Adjustments In The Medication Regimen And Or The Management Of The Condition Is Unusually Complex Due To Comorbidities Ongoing Communication And Care Coordination Between Relevant Practitioners Furnishing Care First 30 Minutes Of Clinical Staff Time Directed By Physician Or Other Qualified Health Care Professional Per Calendar Month |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99424. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 99424 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
FREE SAMPLE MARKET COMPARISON
Let's review your payer contracts side-by-side with the market.
Bring your top codes (like CPT 99424) and we'll show you how you compare in 15 minutes or less.
Frequently Asked Questions
To find out the estimated cost of a specific medical procedure or service, you can use Payerprice's fee schedule lookup tool. This tool allows you to search by the CPT code for the service and your specific location to get pricing insights. It's also recommended to contact your healthcare provider and insurance company directly for the most accurate information based on your individual plan and situation.
You can look up CPT (Current Procedural Terminology) codes and their associated prices using Payerprice's fee schedule lookup tool. This tool enables you to input a CPT code and your specific location to find relevant pricing information for various medical services.
Yes, Payerprice offers a fee schedule lookup tool that can help you compare prices for healthcare services in your area. By searching with a CPT code and your specific location, you can gain a better understanding of the cost variations for different services.
A CPT (Current Procedural Terminology) code is a standardized five-digit alphanumeric code used by medical professionals to describe medical, surgical, and diagnostic services. It is crucial for understanding medical costs because these codes are universally used for billing and determining reimbursement from insurance companies. Knowing the CPT code for a service allows you to research potential costs more effectively, for instance, by using Payerprice's fee schedule lookup tool which searches by CPT code and specific location.
Medical prices can vary significantly due to numerous factors, including different negotiated rates with insurance companies, varying overhead costs, the type and reputation of the facility, equipment, staff expertise, geographic location, and whether the provider is in-network or out-of-network for a particular insurance plan. To get an idea of potential costs for specific services in your area, you can use Payerprice's fee schedule lookup tool, which allows you to search by CPT code and specific location.