Care Management

Principal Care Management

Table of Contents

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Billing Codes

  • 99424: PCM services for a single high-risk disease first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month.
  • 99425: PCM services for a single high-risk disease each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month. List separately in addition to primary.
  • 99426: PCM, for a single high-risk disease first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month. 
  • 99427: PCM services, for a single high-risk disease each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month. List separately in addition to primary.

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Documentation

  • One complex chronic condition lasting at least three months.
  • Disease-specific care plan is required
  • Condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities

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PCM Care Plan

  • List of patient’s problems and conditions
  • Expected outcome and prognosis with measurable treatment goals
  • Cognitive and functional assessments
  • Symptoms management
  • Planned interventions
    • Identification of individuals responsible for interventions
  • Medication management
  • Environmental evaluation
  • Caregiver assessment
  • Coordination with outside resources and providers
  • Requirements for periodic review and revision of plan
  • Referrals applicable to condition
  • Support of referral by creating and exchanging summary of care document

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Related Content

Revised 10/12/2023