Principal Care Management (PCM) FAQs

What CPT codes are used for Principal Care Management?

Principal Care Management services use the following CPT codes:

• 99424: First 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
• 99425: Each additional 30 minutes of clinical staff time directed by a physician or other qualified health care professional, per calendar month.
• 99426: First 30 minutes of physician or other qualified health care professional time, per calendar month.
• 99427: Each additional 30 minutes of physician or other qualified health care professional time, per calendar month.

What is the reimbursement rate for PCM services?

Reimbursement rates vary by payer and geographic location. For Medicare, the 2024 national average payment rates are approximately:

• 99424: $78-$83
• 99425: $56-$60
• 99426: $94-$99
• 99427: $70-$75

Commercial payers typically follow Medicare rates but may vary. Mahalo's platform automatically tracks time and suggests the appropriate billing codes.

How does PCM differ from CCM billing?

While both PCM and CCM are care management services, they differ in key ways:

• PCM: Focuses on a single high-risk chronic condition expected to last 3+ months and requiring significant care coordination.
• CCM: Requires two or more chronic conditions expected to last 12+ months.

PCM is often provided by specialists, while CCM is typically managed by primary care. Mahalo's platform helps you correctly document and bill for both services.