- There are four principal care management codes
- 99424 and 99425 are for time spent by a physician or other qualified health care professional (someone with E/M in their scope of practice) and 99426 and 99427 for clinical staff time directed by a physician or other qualified health care professional
- These are time based codes used for managing a patient with a single, complex chronic condition
CPT® defines these services as services
“that focus on the medical and/or psychological needs manifested by a single, complex chronic condition expected to last at least 3 months and includes establishing, implementing, revising, or monitoring a care plan specific to that single disease.” .
The chronic care management (CCM) codes require that a patient has two or more chronic conditions.
These codes and services are similar to CCM codes. PCM requires a disease-specific care plan, not a comprehensive care plan. Systematic needs assessment and receipt of preventive services are only required if applicable to the condition being treated. CMS states that written or verbal consent are required, and must be documented in the medical record.
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