Principal Care Management (PCM), a sibling of Chronic Care Management (CCM), was introduced by CMS in 2020 as a
tool for specialty providers, such as oncologists, to use to help patients and providers better manage care in between
visits for those patients with a high-risk or chronic condition.
Principal Care Management is a model for the care of patients with a
chronic illness for a period lasting three or more months.
According to CMS, a patient must also have had either a recent
hospitalization or an acute risk of death, exacerbation or functional
decline, or require management that’s “unusually complex due to
comorbidities.”
FAQs
Principal Care Management (PCM)
Billing Codes
- 99424 99425– Principal care management services, for a single highrisk disease physician or other qualified health care professional, per calendar month * each additional 30 minutes
- 99426Principal care management services, for a single high… first 30 minutes provided personally by a ngl risk disease, first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month
- 99427 each additional 30 minutes
What are the requirements for patient qualification?
The qualifying condition for reporting PCM codes would be a patient with one serious chronic condition, typically expected to last at least three months, and includes “establishing, implementing, revising, or monitoring a care plan specific to that single disease.”
What documentation is required?
In addition to time, the provider/clinical staff must document the following required elements, per CPT:
- One complex chronic condition expected to last at least three months, that places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death
- The condition requires development, monitoring, or revision of diseasespecific 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