- CMS’s 2020 Physician Fee Schedule Final Rule adopted two new care management codes, Principal Care Management Services, for use by physicians who are managing a patient with a single, complex problem
- G2064 is for use by physicians and non-physician practitioners, and G2065 for us by clinical staff CMS said that it expects “that most of these services will be billed by specialists who are focused on managing patients with a single complex chronic condition requiring substantial care management.”
- The AMA did not develop CPT codes for these services in 2021.
CMS developed these PCM codes to provide 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 between 3 months and a year, or until the death of the patient that may have led to a recent hospitalization, and/or place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline.
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