Principal Care Management
The Centers for Medicare and Medicaid Services (CMS) introduced Principal Care Management (PCM) to cover patients with a single serious chronic condition. This enables care management for patients who don’t qualify for CCM’s 2-condition requirement.
PCM expands providers’ ability to provide comprehensive care while generating a unique and significant new source of revenue.
The report by CDC’s National Center for Chronic Disease Prevention and Health Promotion states that
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47% About 47% of the U.S. population, over 150 Million, suffer from at least one chronic disease.
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$3.5 Trillion About 90% of the nation’s $3.5 trillion in annual health care expenditures are attributed to people with chronic and mental health conditions.
Significance of Medicare PCM Services
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Reduced hospital and ER admissions
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Improved patient health awareness
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Increased reimbursements and MIPS scores
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Improved patient satisfaction and outcomes
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Reduced patient healthcare costs
PCM by Specialties
The specialties that manage a number of high risk or high complexity conditions that would qualify for PCM services include but are not limited to
- Cardiology
- Gastroenterology
- Oncology
- Neurology
- Pulmonology
- Endocrinology
- Nephrology
- Rheumatology
- Geriatrics
LevelUp Principal Care Management Services
Our team of skilled care managers helps providers seamlessly deliver Medicare PCM services. We help identify eligible patients, accelerate enrollment, document medications, capture accurate time spent with patients, generate billing reports based on CMS guidelines for guaranteed reimbursement.
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Secure Online Web Portal The providers will have access to their own secure and HIPAA-compliant web portal.
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Simple Setup and Configuration Our hassle-free setup does not involve any complex installations. You can be up and running in just 48 hours!
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Accelerated Patient Enrollment Our specialized enrollment team will contact patients, educating and enrolling those who consent.
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Documentation for CMS Audits We mitigate the risks of CMS audits with meticulous time tracking, documentation, and reporting.
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CMS Guideline Changes We are flexible enough to accommodate the CMS changes and additional CPT codes based on the practice needs.
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Data Analytics & Reports Our provider dashboard offers customizable reports and insights, helping you make informed decisions.
Why Choose LevelUp for PCM Services
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Disease-Specific Care Coordination
PCM is focused on addressing the single chronic condition, allowing physicians to devise and implement a disease-specific care plan to better manage patient outcomes in-between visits.
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Better Patient Engagement
This targeted approach keeps patients better engaged and actively involved regarding their health goals and outcomes while aiming to minimize the onset of further complications.
Eligibility Criteria for Patients
Patients covered by PCM codes must meet the following criteria defined by CMS.
- They have one complex chronic condition expected to last between three months and a year, or until the death of the patient.
- The condition is severe enough that the patient is at risk for hospitalization or was recently hospitalized due to the condition.
- The condition requires the development or revision of a disease-specific care plan.
- The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.
Medicare PCM Reimbursement Codes
CMS allows providers to be reimbursed for PCM, offering an additional revenue stream for your practice. PCM services should not be reported at the same time as Chronic Care Management services or Interprofessional Consultations. Patients may receive PCM services from more than one clinician for different conditions.
CPT Code: G2064
Practices may bill G2064 for 30 minutes of physician time per month at $78.68 per patient.
To meet CMS requirements, the practice must provide comprehensive care management services for a single high-risk disease, at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements:
- One complex chronic condition lasting at least 3 months, which is the focus of the care plan,
- The condition is of sufficient severity to place the patient at risk of hospitalization or has been the cause of recent hospitalization,
- The condition requires development or revision of a disease-specific care plan,
- The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
CPT Code: G2065
Practices may bill G2065 for 30 minutes of clinical staff time per month at $39.70 per patient.
To meet CMS requirements, the practice must provide comprehensive care management for a single high-risk disease, at least 30 minutes of clinical staff time directed by a physician or other qualified healthcare professional per calendar month with the following elements:
- One complex chronic condition lasting at least 3 months, which is the focus of the care plan,
- The condition is of sufficient severity to place the patient at risk of hospitalization or has been the cause of recent hospitalization,
- The condition requires development or revision of a disease-specific care plan,
- The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities
Billing Guidelines:
- PCM limits billing by the same practitioner for the same patient simultaneously with other care management services.
- The same practitioner cannot bill for the same patient during a surgical global period.
- Remote Patient Monitoring (RPM) can be billed concurrently with PCM as long as the time is not counted twice.
- Chronic Care Management (CCM) cannot be billed concurrently with PCM by the same billing practitioner.
