Principal Care Management (PCM)

Principal Care Management (PCM)

Principal care management (PCM) specifically relates to a single chronic care condition. To effectively manage a single chronic condition, healthcare providers often follow evidence-based guidelines and best practices for that condition. Examples of conditions we serve:

Chronic Kidney Disease (CKD)

Emphasizing personalized care plans, ongoing monitoring, and timely interventions to address the unique needs of patients. The objective is to improve outcomes, slow disease progression, and enhance overall quality of life.


Monitoring blood pressure, prescribing antihypertensive medications, and encouraging lifestyle changes.

Heart Disease

Managing cholesterol levels, blood pressure, and promoting heart-healthy habits.


Employing psychotherapy, prescribing antidepressants, and monitoring treatment progress.


Regular blood glucose monitoring, medication adherence, lifestyle modifications, and foot care education.


Creating an action plan, prescribing inhalers, and monitoring lung function.

Chronic Obstructive Pulmonary Disease (COPD)

RPM enables personalized care plans based on individual health data, improving treatment outcomes.

Liver Disorders

Managing Liver Cirrhosis, Hepatic encephalopathy, End stage liver disease, providing education on GI disorder with increased medication compliance

Patient eligibility:

  1. Patient must have a complex chronic condition lasting a minimum of three months.
  2. The condition must be of sufficient severity, putting the patient at risk of hospitalization or having caused a recent hospital stay.
  3. It necessitates the development or revision of a disease-specific care plan.
  4. Frequent adjustments in the medication regimen are required, and the condition’s management is unusually complex due to comorbidities.

CPT Codes For PCM

CPT 99426

PCM performed by clinical staff under the direction of a physician or other qualified health care professional 30 minutes per month.

CPT 99427

Additional 30 minutes per month.

Principal Care Management (PCM) FAQs

PCM is a focused approach to managing a single chronic condition. It involves following evidence-based guidelines and best practices specific to that condition.

Patients with a single significant chronic condition that requires specialized care and management over a prolonged period are ideal candidates for PCM.

PCM includes developing and monitoring a care plan specific to the patient’s chronic condition, coordinating care among specialists, and providing targeted support and education.

PCM is billed using specific CPT codes that reflect the time and complexity of managing a single chronic condition. These codes are used for the monthly management and oversight of the patient’s care.

Unlike CCM, which addresses multiple chronic conditions, PCM focuses on managing a single chronic condition with a dedicated care plan and management strategy.