- Principal care management CPT codes.
Do you know the rates and workflow for this program?
In this video, we'll break down everything you need to know
for principal care management, or PCM,
in order to properly bill and code
in order to maximize your revenue.
(gentle music)
Hi. This is Loran from ThoroughCare.
Here at ThoroughCare, we help practices like yours every day
to properly manage, bill, and streamline programs
like principal care management.
Knowing the billing codes for PCM will give you
a better understanding of what's expected
by your insurances, your providers, and your care team.
There are two series of CPT codes that you'll need to know
based on who is providing these services.
But before we look at the CPT codes,
let's explore how principal care management actually works.
If you're familiar with chronic care management, or CCM,
you're already familiar with PCM.
PCM works very similar to chronic care management,
with the one main difference being that with PCM,
you only manage one chronic condition.
Another key difference between CCM and PCM
is the time spent with your patients needed to bill.
In chronic care management, there is only 20 minutes
of non-face-to-face time needed.
But in principal care management, there is 30 minutes
of non-face-to-face time needed within a calendar month.
This time can either be accrued by a clinician
and/or a physician to meet the requirements
for the CPT codes associated with the program.
Services are delivered through remote
or non-face-to-face interactions
so your patient can stay at home in between visits.
These services include but aren't limited to
telephone calls, referrals, prescription refills,
interactions with other providers, just to name a few.
So what does a patient need
in order to qualify for principal care management?
Well, at first, you need to have
at least one chronic condition
expected to last between three months to a year
or expected to last the remainder of the patient's life.
The patient must also consent
with either verbal or written consent
so they know what they can expect from this program.
This consent must also be documented.
Now, let's look at the CPT code codes needed
to properly bill principal care management.
There are four codes in total, two series of codes.
These can either be codes by clinician time
or physician time.
Let's look at provider time
for principal care management first.
The first code you need to be made aware of
is CPT code 99424.
This takes into account 30 minutes of provider time only.
At 30 minutes, you can bill 99424,
which pays at about $81 national average reimbursement.
There's also another provider code, 99425,
which can be billed on top of 99424 only.
99425 is an additional 30 minutes
on top of the initial 30 minutes.
So think 60 minutes of non-face-to-face provider time.
99425 pays national average reimbursement of $58,
which adds out to about $139 total.
Now, let's talk about clinical CPT codes
for the PCM program.
The first clinical code is code 99426.
99426 is 30 minutes of non-face-to-face time
done by a clinician,
so think a certified resource or hire
who is not a provider at your practice.
99426 pays a national average reimbursement of $61.
The additional add-on code for PCM clinician time is 99427.
Like the provider codes,
99427 can only be billed on top of 99426
after an additional 30 minutes is accrued
past the initial 30 minutes of time.
99427 pays $47 nationally.
At 60 minutes of clinician time,
the national average reimbursement is $108.
Now, recommendations from ThoroughCare for the PCM program:
It's important to note that one provider
cannot bill CCM and PCM within the same calendar month.
So choose wisely on what program you'd like to provide
to a specific patient.
Now, PCM and CCM can be billed by separate providers
for one patient within a month,
but within a practice, it cannot.
Also, a great add-on for principal care management might be
the remote patient monitoring program.
These patients can be given a remote device
that can transmit data or vitals
to your practice in between visits.
Now, PCM and RPM can be billed concurrently
in the same month.
So a great add-on opportunity for better patient care,
for value-based programs,
and also for higher reimbursement opportunities.
So now that you have a better understanding
of principal care management and their CPT codes,
what should you do next?
In the description below,
there is a link to our Learning Center.
Our Learning Center is written
by our on-staff clinician team,
with everything you'll need to know regarding rules,
regulations, tips, tricks,
and answers to the most commonly asked questions
we get here every day at ThoroughCare
regarding value-based programs.
Or if you're ready to talk
about how care coordination software
can help your team reap these benefits,
talk to me or another account manager here at ThoroughCare.
Any additional questions, please feel free to comment below.
Don't forget to subscribe for all of the latest videos,
and we hope to hear from you soon.
(gentle music)