Principal care management (PCM) represents services that focus on the medical and/or psychological needs manifested by a single complex chronic condition expected to last at least 3 months. PCM includes establishing, implementing, revising, and/or monitoring a care plan specific to that single disease. The general guidelines for PCM are shared with CCM; however, the disease intensity for PCM is greater. As this code set is for a single disease focus, there is no requirement to be as “comprehensive” in care planning. Generally, one might expect subspecialists to use the PCM codes and CCM codes to be used by primary care, but that isn't a requirement.
Note: Multiple providers may submit charges for PCM in a given month, but only one may submit CCM codes. Also, the same physician cannot charge both PCM and CCM codes at the same time.
Examples of where PCM might be helpful in Family Medicine could be with new onset or brittle diabetes, where physician and staff time may be more intense for a period of months, but not necessarily requiring face-to-face encounters for all of the work.
These services may be billed once 30 minutes of work time has been performed by clinical staff (99426) or physician (99424). Up to 2 additional 30-minute units may be submitted for staff time (99427). Code 99425 is used for each additional 30-minute increment coded by physicians, with no limit on the number of units.