Principal Care Management (PCM)
Principal Care Management
Care management for Medicare beneficiaries with a single high-risk chronic condition; billed under CPT 99424-99427.
1 min read · Last reviewed May 23, 2026
At a glance
- Category
- Billing
- Acronym for
- Principal Care Management
- Primary sources
- 1
- Workspace handoff
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Where this comes up
This shows up in revenue-cycle work — claim scrubbing, charge entry, posting, A/R follow-up, and month-end close. Billers and practice managers hit this term when reconciling a payment, working a denial queue, or auditing why a claim aged past 60 days.
Full definition
What it is in practice
PCM (effective 2022) covers patients with one high-risk condition expected to last at least three months. Like CCM, it requires care planning, monthly time, and beneficiary consent.
How it shows up in your practice
PCM is a fit for specialists managing a single complex condition. Documentation requirements mirror CCM.
Sources
- CMS — Chronic Care Management Serviceshttps://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/chroniccaremanagement.pdf
Look up PCM rules in Ask D3
Open ask d3 →Related terms
- BillingChronic Care Management (CCM)Care management services for Medicare beneficiaries with two or more chronic conditions; billed monthly under CPT 99490 and related codes.
- BillingTransitional Care Management (TCM)Care management following discharge from an inpatient, partial-hospital, or observation stay; CPT 99495 (moderate complexity) and 99496 (high complexity).
- BillingRemote Physiologic Monitoring (RPM)Codes (CPT 99453-99458) covering the monitoring and treatment management of physiologic data transmitted from a patient's device.
D3rx is a healthcare-billing and compliance research aid maintained by D3rx Inc. Articles are drafted by an LLM (Anthropic Claude) against primary HHS, OCR, CMS, eCFR, NIST, and state-regulator publications, and reviewed for restraint and source fidelity by the D3rx team.
Reviewer status: a named credentialed reviewer (CHC, CHPC, or healthcare attorney) is being engaged. Until that engagement is finalized, this page does not claim credentialed review.
Related across the archive
- GlossaryChronic Care Management (CCM)Care management services for Medicare beneficiaries with two or more chronic conditions; billed monthly under CPT 99490 and related codes.
- GlossaryTransitional Care Management (TCM)Care management following discharge from an inpatient, partial-hospital, or observation stay; CPT 99495 (moderate complexity) and 99496 (high complexity).
- GlossaryRemote Physiologic Monitoring (RPM)Codes (CPT 99453-99458) covering the monitoring and treatment management of physiologic data transmitted from a patient's device.
- GlossaryAdvance Care PlanningDiscussion and documentation of patient's goals, values, and preferences for future medical care; billable under CPT 99497 and 99498.
- GlossaryCollaborative Care Model (CoCM)Integrated primary-care behavioral-health model billable under CPT 99492-99494 and HCPCS G2214.
- GlossaryMedication ReconciliationThe process of creating an accurate list of all medications a patient is taking and comparing it against new orders to identify discrepancies.
- BillingAWV + Problem Visit Same Day: How to Bill CorrectlyYes, you can bill AWV and a problem visit the same day. Here's how to do it correctly with modifier -25.
- BillingPlace of Service Codes: Which One to Use and Why It Changes Your ReimbursementPOS 11 vs 21 vs 02 vs 10. How the two-digit code on your claim determines whether you get office or facility rates.
This glossary entry is a research aid for billing and compliance staff. It does not provide legal, medical, or financial advice and does not replace counsel. References cited link to primary sources at HHS, OCR, CMS, eCFR, NIST, and the relevant payer or industry body.