Principal Care Management
PCM is a model of care focused on patients with a single, high-risk chronic condition expected to last 6 months to 1 year or until the patient’s death and designed to improve health outcomes and reduce complications. PCM concentrates on a specific condition, ensuring comprehensive and coordinated care tailored to the individual's needs.
PCM involves creating a detailed care plan that outlines the patient's treatment goals, interventions, and follow-up schedules. This plan is developed in collaboration with the patient and their caregivers to ensure it aligns with their preferences and lifestyle that includes focused care, disease-specific plan of care, on-going monitoring and modifications, medication management, education to patient, and coordinating care with other specialists when applicable.
By providing focused and coordinated care, PCM aims to improve health outcomes, reduce hospitalizations, and prevent complications.
Table of Contents
Billing Codes
| CPT Codes | Descriptions |
|---|---|
| 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. |
Documentation
Billing PCM codes requires the practitioner to develop a disease-specific care plan including:
- Patient consent
- Use of certified electronic health information technology
- Management of care transitions between and among health care providers and settings, including referrals to other clinicians; follow-up after an emergency department visit; and follow up after discharges from hospitals, skilled nursing facilities or other health care facilities
- Create and exchange/transmit continuity of care document(s) timely with other practitioners and providers
- Copy of the plan of care must be given to the patient and/or caregiver
- Initiate during an AWV, IPPE or face-to-face E/M visit for new patients or patients not seen within one year prior to the commencement of PCM services
- Structured recording of demographics, problems, medications and medication allergies using certified EHR technology: A full list of problems, medications and medication allergies in the EHR must inform the care plan, care coordination, and ongoing clinical care
- Provide 24/7 access to physicians or other qualified health care professionals or clinical staff, including providing patients/caregivers with means to make contact with health care professionals in the practice to address urgent needs regardless of the time of day or day of week
Related Content
- Care Management
- Calendar Year (CY) 2022 Medicare Federal Register
- Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services
Revised 7/14/2025