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