Principal Care Management
Table of Contents
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.
Documentation
Billing PCM codes requires the practitioner to develop a disease-specific care plan including:
- Cognitive and functional assessments
- Consent
- Coordination with outside resources and providers
- Documents dates and times
- Educate patient on PCM and cost sharing
- Expected outcome and prognosis with measurable treatment goals
- List core medical problem
- Medications (allergies) and medication management
- Patient’s demographics
- Planned interventions
- Symptoms management
- Requires documentation to substantiate time and patient facts
Related Content
- Care Management
- Calendar Year (CY) 2022 Medicare Federal Register
- Frequently Asked Questions About Practitioner Billing for Chronic Care Management Services
Revised 7/31/2024