October 9, 2025
Principal Care Management (PCM) refers to non-face-to-face care coordination and clinical management for patients with a single, serious chronic condition expected to last at least three months.Β
It helps ensure ongoing monitoring, care planning, and communication between the patient and healthcare provider.
Introduced by CMS (Centers for Medicare & Medicaid Services), PCM services fill the gap for patients who donβt meet the Chronic Care Management (CCM) criteria, which requires two or more chronic conditions.
Principal Care Management (PCM) is a healthcare model developed to cater to patients with a single chronic condition that has lasted for at least three months. According to the Centers for Medicare and Medicaid Services (CMS), PCM focuses on dealing with conditions that place patients at a high risk of:
Feature | Principal Care Management (PCM) | Chronic Care Management (CCM) |
Condition Requirement | One chronic condition | Two or more chronic conditions |
Primary CPT Codes | 99424, 99425, 99426, 99427 | 99490, 99439, 99487, 99489 |
Focus | Management of a single complex illness | Comprehensive management of multiple conditions |
Provider Involvement | Physician or qualified healthcare professional | Physician or clinical staff under supervision |
Time Spent | 30+ minutes per month | 20+ minutes per month |
Below are the key PCM CPT codes and their descriptions:
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To ensure compliance and proper reimbursement, healthcare providers should follow CMS billing rules for PCM:
Key Requirements:
PCM and CCM cannot be billed for the same patient in the same month.
However, a patient can transition from PCM to CCM once they develop two or more qualifying conditions.
This transition must be documented in the medical record with updated care plans.
Implementing PCM programs offers several benefits for healthcare practices:
Principal Care Management (PCM) is an essential tool for physicians aiming to provide continuous care to patients with one high-risk chronic condition. When implemented correctly, PCM improves patient outcomes, ensures timely intervention, and strengthens practice revenue through consistent reimbursement.
Optimize your PCM billing and compliance with Cures Medical Billing. Our experts handle care management documentation, coding, and reimbursement so you can focus on patient care.
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PCM refers to the ongoing management of a single, serious chronic condition by a healthcare professional through non-face-to-face services.
PCM uses CPT codes 99424, 99425, 99426, and 99427 to bill for 30-minute intervals of care coordination and follow-up.
No. PCM and CCM cannot be billed together in the same month for the same patient.
Providers must include patient consent, condition details, a care plan, communication records, and time logs of PCM activities.
PCM services can be performed by a physician, nurse practitioner, or qualified healthcare professional, and by clinical staff under supervision.
PCM manages one chronic condition, while CCM addresses two or more chronic conditions.
PCM focuses on single-condition care coordination.
Yes, Medicare covers PCM services under the 99424β99427 CPT codes, subject to documentation and eligibility requirements.
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