Harnessing the power of remote patient monitoring (RPM) has allowed physicians’ offices to realize new revenue streams, provide efficient care, and improve patient outcomes. However, virtual care– also known as telehealth—is far from one-dimensional.

 What is Principal Care Management (PCM), CPT Codes, Requirements and More

Depending on your patients’ needs, they may require transitional care management (TCM), chronic care management (CCM), or a similar option called principal care management (PCM).

Understanding the unique role PCM plays in patient care can help your office take full advantage of this growing—and lucrative—care model. More importantly, it can make your office more efficient without compromising the quality of care you’re committed to delivering.

What is Principal Care Management (PCM)?

Principal care management (PCM) is targeted preventive care focused on a single chronic health condition.

PCM helps patients reduce symptoms and minimize harm from significant chronic conditions, especially after they’ve been discharged from an inpatient facility.

For many patients, PCM pairs well with remote patient monitoring (RPM), which involves collecting and transmitting health data in real time using wearable monitoring devices. This enables providers to check in on patients from a distance, identify early signs of symptom flare-ups, treatment nonadherence, or other concerns.

The primary goal of PCM is patient stabilization. Clinicians aim to help patients manage ongoing health conditions effectively while maintaining independence—and PCM supports that mission.

Principal Care Management Requirements

The Centers for Medicare and Medicaid Services (CMS) have implemented strict guidelines for principal care management. Below are key requirements your clinic’s staff should know:

  • PCM addresses only one chronic condition that has been present for at least three months.
  • The chronic condition must pose an acute risk of death, functional decline, or exacerbation; it must also require “unusually complex” management.
  • Doctors, qualified health professionals (QHPs), or clinical staff spend at least 30 minutes with PCM patients per month. These principal care management services may include virtual patient consultations, chart analyses, prescription refills, or physical reviews, to name four.

Conditions that commonly qualify for PCM services include:

  • Heart disease
  • HIV
  • Arthritis
  • Diabetes
  • Asthma

Principal Care Management CPT Codes & Reimbursement

The four primary PCM CPT codes under Medicare Part B are relatively new and remain underused by many clinicians:

Principal Care Management (PCM)

CPT Code

2025 CMS Reimbursement Rate*

Description

99424

$83.40

A physician or QHP (provider) spends a minimum of 30 minutes per month on PCM services.

99425

$60.22

Each additional 30 minutes spent per month on PCM services.

99426

$62

A member of your clinical staff (non-physician or QHP) spends at least 30 minutes per month on PCM services.

99427

$50

Each additional 30 minutes of staff time spent on PCM services.

*Reimbursement rates are based on national averages and may vary based on your location. Consult the Physician Fee Schedule for the most updated information.

The need for frequent adjustments to care plans is built into PCM billing guidelines. Don’t hesitate to spend the time needed with your patients.

PCM with Remote Patient Monitoring

RPM equipment and software are often critical components of PCM, helping patients take a more active role in their care. RPM is especially valuable for older adults who may face mobility challenges or lack reliable transportation.

Commonly used durable RPM equipment includes:

  • Spirometers
  • Pulse oximeters
  • Blood glucose meters
  • Blood pressure monitors
  • Wearable activity trackers

Your practice can create reimbursement synergy by pairing PCM services with RPM services—each with its own CPT codes. However, note that time spent on PCM and RPM services cannot be billed concurrently.

CoachCare Supports Simplified Principal Care Management

Following transitional care, patients with chronic conditions have an opportunity to mitigate symptoms and embrace preventive care.

The months following a hospital or inpatient stay are crucial for effective health management, and your office can use principal care management to meet these needs. Better yet, you can do so while ensuring everyone’s time gets used as efficiently as possible.

You and your staff deserve to work with an RPM vendor that understands the importance of the finer details. At CoachCare, we’re meticulous about CMS billing requirements and other regulations, so you can focus on what matters most: improving patient outcomes. We’d be happy to explain our RPM devices in more detail or schedule a demo for your team.