Care Management
Principal Care Management
2022 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.
2021 and Prior Billing Codes
- G2064: 30 minutes
- physicians and nonphysician practitioners
- G2065: 30 minutes
- for use by clinical staff
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
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
Resources
Revised 5/18/2022