The four new PCM (principal care management) codes are intended to reimburse physicians, mid-levels and/ or their care teams for the additional work they do caring for high risk, complex patients. The physicians can bill these services under general supervision in case they want to work with a firm to provide a care team as an extension of their practice.
PCM services can include the extra time and work required for medication adjustments, creating a care plan, patient follow-up and more.
PCM services for a single high-risk chronic condition – first 30 minutes provided personally by a physician or other qualified health care professional, per calendar month $83.40.
PCM services for a single high-risk chronic condition – each additional 30 minutes provided personally by a physician or other qualified health care professional, per calendar month $60.22
PCM services for a single high-risk chronic condition – first 30 minutes of clinical staff time directed by physician or other qualified health care professional, per calendar month $63.33.
PCM services for a single high-risk chronic condition – each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month $48.45.
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PCM annual payment CPT 99426 for 30-59 minutes (U.S. average: $61.92) or select your locality below (approx. 85% of PCM patients). |
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PCM annual payment CPT 99427 for 60+ minutes (U.S. average: $47.27 ) or select your locality below (approx. 20% of PCM patients). |
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| Estimated annual PCM reimbursement for a specialty provider | |
| Revenue Calculator | Your Value |
Reimbursement amount from the CY 2024 Physician Fee Service Final Rule averaged across 89 localities.
Since using CareVitality’s Virtual Care Management team we have not only increased revenue to our office from additional reimbursement for the CCM service codes but our MACRA/ MIPS score has increased due to the additional support they provide to help us improve our patients outcomes by providing these services in between their office visits or…
Working with CareVitality’s Care Management team has not disrupted our workflow and has improved the care we provide to our patients. They identify themselves as part of our practice and use a caller id with our practice name and phone number similar to our office to provide seamless services to our patients.
CareVitality’s Virtual Care Management team is well rounded in both medical, mental health and behavioral health services to complete comprehensive care plans to service our patients. The RNs we have worked with have had 30+ years of nursing experience and have been detailed in their work that when it comes to our providers to review…
CareVitaity’s Virtual Care Managers have helped us successfully implement our Chronic Care Management Program. Their detailed understanding of how to successfully launch a chronic care management program along with their Virtual Care Managers explaining to the patient the benefits of receiving chronic care management services coupled with putting together a comprehensive patient centric care plan…
We have used CareVitality for two years now to attest our MIPS/MACRA and they have done a great job! I would recommend them for any service they provide.
Care Vitality is an efficient Chronic Care Management company. Vanessa is very knowledgeable and the company provides conferencing and reports that will keep a Medical Practice up-to-date with the latest information from onboarding employees to CMS rules. I highly recommend Chronic Care Management for their efficiency, professionalism, and knowledge !!!
Contact Us Today to Learn How We Can Successfully Assist You in Participating in the Principal Care Management (PCM)