CPT 99425 Fee Schedule

Last Verified: January 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.

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)

Key Fact	Detail
Service Type	• Evaluation and Management • Preventive Medicine Services
Common Place of Service	• 11 - Office • None • 99 - Other POS
Common Modifiers	• None • 25 - Significant, separately identifiable E/M service same day • GT - Via interactive audio and video telecommunication systems
Complexity Level	Low

National average reimbursement for CPT 99425 by major payers:

$72.78

$77.24

$64.33

$105.55

Preview provider-level rates for...

For billing codeCPT 99425

Payer	Code	Rate	NPI	Tax ID	State	Specialty
Select a payer to view fee schedule data Choose a payer from the options above to see rates for CPT 99425
United	99425	$70.33	1124495718 - PERIOPERATIVE AND TRANSITIONAL MEDICINE GROUP PLLC	474843039 - (TX) PERIOPERATIVE AND TRANSITIONAL	TX	Internal Medicine Physician (207R00000X)
United	99425	$110.47	1942267802 - MICHAEL KWAN	262400924	TX	Cardiovascular Disease Physician (207RC0000X)
United	99425	$80.44	1538273180 - C. BROWN	823426999	TX	Internal Medicine Physician (207R00000X)
United	99425	$43.88	1235230574 - THOMAS PORTER	113738145 - (TX) PORTER HEALTHCARE SERVICES INC	TX	Internal Medicine Physician (207R00000X)
United	99425	$56.52	1013913581 - ANTHONY PHI	852887931 - (TX) WILLOWCHASE MEDICAL PLLC	TX	Internal Medicine Physician (207R00000X)
United	99425	$53.38	1275689655 - ANDREW SEGAL	201478028 - (TX) ANDREW SEGAL MD PA	TX	Cardiovascular Disease Physician (207RC0000X)
United	99425	$126.27	1689194789 - LUIS SEGURA	752896138 - MEDHEALTH	TX	Internal Medicine Physician (207R00000X)
United	99425	$159.72	1265011043 - COLE MARTENS	203682536 - BELMONT CAMBRIDGE HEALTH CARE PC	MA	Pediatrics Physician (208000000X)
United	99425	$82.08	1144213869 - SURYA LANKA	752497784 - SURYA P. LANKA, M.D.	TX	Internal Medicine Physician (207R00000X)
United	99425	$143.49	1265663710 - JOCELYN SZETO	760386391 - KELSEY-SEYBOLD MEDICAL GROUP PLLC	TX	Internal Medicine Physician (207R00000X)
United	99425	$103.62	1710366026 - RACHAEL JACOBSON	742958277 - SCOTT & WHITE CLINIC	TX	Internal Medicine Physician (207R00000X)
United	99425	$75.55	1790743649 - MARY ELIZABETH MIOTTO	42544151 - (MA) MATTAPAN COMMUNITY HEALTH CENTER INC	MA	Pediatrics Physician (208000000X)
United	99425	$72.43	1851752307 - TIMOTHY MURPHY	640819193 - (MS) WEBSTER HEALTH SERVICES INC	TX	Internal Medicine Physician (207R00000X)
United	99425	$179.83	1831574045 - DEVINA SAVANT	42807148 - MASS GENERAL BRIGHAM INCORPORATED	MA	Pediatrics Physician (208000000X)
United	99425	$56.52	1275534109 - MICHELLE SCANLAN	742518083 - (TX) PASTEUR MEDICAL ASSOCIATES PA	TX	Internal Medicine Physician (207R00000X)
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist
United	99202	$100.00	1234567890	1234567890	CA	Cardiologist

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CPT 99425 vs. Other Preventive Medicine Services Codes

The CPT 99425 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 99425 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 Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days; 5-10 Minutes
99422-CPT	Low	Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days; 11-20 Minutes
99423-CPT	Low	Online Digital Evaluation And Management Service For An Established Patient For Up To 7 Days Cumulative Time During The 7 Days; 21 Or More Minutes
99425-CPT	Low	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)

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 99425. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 99425 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.

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