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Beginning in 2020, the Centers for Medicare and Medicaid Services (CMS) created a new program called Primary Care Management, also known as Principal Care Management (PCM).
The service is intended to provide additional care to patients with a single chronic condition or allowing a provider to treat a patient with multiple chronic conditions by focusing care solely on one of those chronic conditions.
Previously, CMS only allowed practices to be reimbursed for treating patients with two or more chronic conditions under their Chronic Care Management (CCM) program.
PCM was created to fill in the gaps, as many practices do see patients with only one chronic condition, but could stand to benefit greatly from focused care.
ValueCare Suite's tools for improved workflow
Daily Management Tools
We help you track and bill for services including communication with the patient and other treating health professionals for care coordination (both electronically and by phone), medication management, and being accessible 24 hours a day to patients and any care providers (physicians or other clinical staff).
Total Care. Wherever they go.
Primary Care Management
These are the codes you can use to bill Medicare for reimbursement of health care services rendered for a primary care management patient.
The monthly income is based on the national average of reimbursement.
CPT 99426
PCM Monitoring-
Initial 30 minutes, clinical staff
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Follow up calls
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Vital tracking & more
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Plan adjustements
CPT 99427
Additional PCM-
PCM, clinical staff, +30 min.
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Follow up calls
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Vital tracking & more
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Plan adjustements
CPT G0511
Care mgt., RHC/FQHC*-
Rural Health Clinic, clinical staff or Federally Qualified Health Center, +30 min.
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Follow up calls
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Vital tracking & more
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Plan adjustements
CPT 99424
(previously G2064)-
Initial 30 minutes, physician or NPP
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Follow up calls
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Vital tracking & more
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Plan adjustements
CPT 99425
Additional PCM-
Subsequent 30 minutes, physician or NPP
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Follow up calls
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Vital tracking & more
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Plan adjustements
Predictable Reimbursements
Increase practice revenue with predictable reimbursements in ValueCare Suite.
Automatically calculate multiple billing codes simultaneously without duplication of services.
ValueCare Suite has partnered with BlackBox RPM
We’ve partnered with BlackBox RPM hardware to provide a seamless end-to-end care experience for physicians and patients.
BlackBox‘s monitoring hardware is proven to be accessible for patients with minimal steps including equipment set-up, with one step, seamless capture and electronic transmission of data.
