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March 25, 2023

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

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  • 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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Relevant Search Terms: PCM, CCM, chronic care management, specialty billing

CPT is a registered trademark of the American Medical Association Copyright 2022, American Medical Association All rights reserved.

Last revised January 4, 2023 - Betsy Nicoletti
Tags: care management

CPT®️️ is a registered trademark of the American Medical Association. Copyright American Medical Association. All rights reserved.

2023 E/M reference sheets

These handy quick reference sheets included at-a-glance MDM requirements for office, hospital, nursing home and home and residence services. And, a bonus sheet with typical time for those code sets. Sign up for Betsy’s monthly newsletter to download these reference sheets and share them with your practitioners.

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2023 E/M guidelines for hospital, nursing facility, home and residence services | Webinar

Effective January 1, 2023, the AMA has revised the definitions and guidelines for hospital and other E/M services, including ED visits, nursing facility services, home services, and domiciliary care codes. Also, coding for prolonged care services gets another overhaul with revised codes and guidelines. Watch this webinar about all these changes.

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Our mission is to provide up-to-date, simplified, citation driven resources that empower our members to gain confidence and authority in their coding role.

In 1988, CodingIntel.com founder Betsy Nicoletti started a Medical Services Organization for a rural hospital, supporting physician practice. She has been a self-employed consultant since 1998. She estimates that in the last 20 years her audience members number over 28,400 at in person events and webinars. She has had 2,500 meetings with clinical providers and reviewed over 43,000 medical notes. She knows what questions need answers and developed this resource to answer those questions. For more about Betsy visit www.betsynicoletti.com.

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