Our integrated approach to principal care management allows us to deliver care to patients suffering from one single chronic condition by enhancing quality metrics of their healthcare.
60%
U.S. adults are living with a chronic disease
7/10
Deaths among U.S. adults due to chronic diseases
Identify Eligible Patients
Patients who are eligible for chronic care management will have one chronic conditions expected to last at least 12 months or until the patient's death. This condition must place the patient at significant risk of death, acute exacerbation and or decompensation, or functional decline.
Examples include but are not limited to: Alzheimer's, dementia, arthritis, asthma, atrial fibrillation, autism, cancer, cardiovascular disease, COPD, depression, diabetes, hypertension, infectious diseases like HIV and AIDS.
Obtain Patient Consent
Get the patient's written or verbal consent for PCM services before starting PCM. This helps ensure patients are aware and approve of the monthly service. Patients can give consent digitally, verbally, or while at the practice. Patients have the right to stop PCM services at any time. Only 1 practitioner can furnish and bill PCM services during a calendar month.
Develop Comprehensive Care Plan
Develop a comprehensive, person-centered, electronic care plan based on the patient's medical, functional, and psychosocial needs. The plan will help support disease control and health management goals, including physical, mental, cognitive, psychosocial, functional, and environmental factors. Patients may also receive a list of suggested resources and community services.
Monthly CCM for at least 30 Minutes
Our care managers provide patients with care management services once monthly for at least 30 minutes. This includes helping beneficiaries manage their medications, performing a structured clinical summary, providing patient education, and documenting patient interactions.
Provider Billing for Reimbursement
Time spent providing these services will be tracked and shared with provider in order to bill Medicare. Our platform collects records of calls and other interactions, connects them to the appropriate patients, and then generates a single billing report. Our company does the work, and the provider generates additional revenue streams.
CPT Codes for Chronic Care Management
CPT Code 99424
The first 30 minutes of a Principal Care Management service per calendar month provided by a physician or qualified healthcare professional.
Reimbursement: $83.4
CPT Code 99425
To capture each additional 30 minutes of service in addition to 99424, CPT code 99425 would be reported.
Reimbursement: $60.2
CPT Code 99426
This covers the first 30 minutes of PCM clinical staff time, as carried out by clinical staff (such as nursing professionals) under the direction and guidance of a physician or QHCP.
Reimbursement: $63.3
CPT Code 99427
It involves additional 30 minutes of PCM clinical staff time, as carried out by clinical staff (such as nursing professionals) under the direction and guidance of a physician or QHCP.
Reimbursement: $48.4
" - Payments vary with subject to specific locations - Please refer to cms.gov
Frequently Asked Questions
+ What is principal care management? Fundamentally, principal care management is a model for the care of patients with a chronic illness for a period lasting three or more months. According to the CMS definition (via the AACP), the patient must also have had either a recent hospitalization or an acute risk of death, exacerbation or functional decline, or require management that’s “unusually complex due to comorbidities.”
+ What are the Principal Care Management (PCM) CPT Codes? Principal Care Management (PCM) utilizes CPT codes 99424 and 99425 for the Physician/NPP's initial 30 minutes and additional 30 minutes, respectively. It also employs 99426 and 99427 to document and bill for the clinical staff's time of 30 minutes and each incremental 30 minutes, respectively, dedicated to supporting patients with specific chronic conditions. These codes facilitate meticulous tracking of patient care, ensuring individuals receive personalized attention and comprehensive management to navigate their health challenges effectively.
+ Key Requirements for Billing the Principal Care Management (PCM) CPT Codes The key requirements include: Checking patients' eligibility for PCM and receiving patient consents. Patients need a single, serious, and complex chronic condition. Providers/Clinical Staff meet monthly time thresholds (30 minutes and additional 30 minutes), documenting care plans and staff involvement. Accurate coding and detailed documentation are essential.