Although chronic care management has been a CMS-covered care model for managing patients with multiple chronic conditions, this year, codes for a similar program were created. Principal care management (PCM) is a “sister” model – if you will – geared to patients with only one chronic medical condition. The goal of this program is two-fold: improving the patient’s quality of life & medical status, and avoiding costly decompensations in the patient’s health.

PCM is for patients who have had a recent hospitalization, an acute risk of death, exacerbation or functional decline, or require management that’s unusually complex due to comorbidities.

The first step is for the provider to create a disease-specific care plan. As the provider implements the plan, adjustments may be necessary in order to stabilize the patient’s condition. This medical dance involves not only the medical provider but clinical staff members who continue the program by communicating regularly with the patient to monitor his/her condition and coordinate additional care.

It’s important to keep in mind these parameters in order to incorporate PCM successfully into your practice:

  • PCM is for patients with a complex chronic condition that is expected to last at least three months.
  • It’s for patients at high risk for hospitalization, exacerbation, decline or death.
  • The condition requires a specific care plan that is often subject to revision or tweaking.
  • The condition requires frequent adjustments in medication, or the complexity of care is complicated by the patient’s comorbidities.

At least 30 minutes of care per month must be provided by the medical practitioner (CPT code 99424; use 99425 for each additional 30 mins of provider time). Staff may also provide services as they implement and manage the patient’s care plan (CPT code 99436 for the first 30 mins; use 99427 for each additional 30 mins of staff time as directed by the medical provider).