Principal Care Management (PCM) Services – CPT codes in 2022: 99426—99427

• 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 care management services for patients with a single high-risk disease or complex condition.  The existing chronic care management (CCM) codes require that a patient has two or more chronic conditions. The qualifying condition for reporting PCM codes would be a patient with one serious chronic condition, typically expected to last at least three months, and includes “establishing, implementing, revising, or monitoring a care plan specific to that single disease.” CPT® 2023.

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