{"id":25872,"date":"2024-01-16T12:13:45","date_gmt":"2024-01-16T17:13:45","guid":{"rendered":"http:\/\/www.carecloud.com\/continuum\/?p=25872"},"modified":"2025-10-22T14:07:05","modified_gmt":"2025-10-22T14:07:05","slug":"rules-for-principal-care-management","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/rules-for-principal-care-management\/","title":{"rendered":"Principal Care Management Rules for Providers"},"content":{"rendered":"

Principal care management (PCM) is a model of care for reimbursement of services provided to patients with one chronic condition. It is similar to the chronic care management (CCM) and transitional care models (TCM), with a bit of difference. In this article, we will provide a comprehensive guide to principal care management (PCM) and the rules providers need to follow when billing for PCM.<\/span>\u00a0<\/span><\/p>\n

What is Principal Care Management?<\/span>\u00a0<\/span><\/h2>\n

Principal care management is a model of care for patients who have been living with one chronic condition for three months or more. According to the <\/span>AACP<\/span><\/a>:<\/span><\/p>\n

“A patient would be eligible for PCM if they have a chronic condition that is expected to last at least three months. It would be a condition that places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death.”<\/span><\/i><\/p>\n

In PCM, patients with chronic conditions require treatment for three months or more, and the need for PCM is judged necessary after a severe episode or hospitalization due to the condition. PCM services usually comprise care that quickly stabilizes the patient’s condition before transferring them to their primary care provider.\u00a0<\/span>\u00a0<\/span><\/p>\n

Usually, the provider or nurse develops a personalized care plan specific to the patient’s condition. The staff follows this care plan to provide healthcare services to the patient. This includes regular communication with the patient, monitoring and managing the patient’s condition and medicines, and other necessary tasks.<\/span>\u00a0<\/span><\/p>\n

PCM Time Considerations<\/span>\u00a0<\/span><\/h2>\n

In 2022, CPT guidelines replaced two obsolete HCPCS Level II comprehensive care management services codes, G2064 and G2065, with three <\/span>new PCM codes<\/span><\/a>:<\/span>\u00a0<\/span><\/p>\n

99424<\/span><\/h3>\n

Principal care management services for a high-risk disease with the following elements:\u00a0<\/span>\u00a0<\/span><\/p>\n