The introduction of the new care coordination program for managed care has shown remarkable results in reducing hospitalizations and cost of managing chronic conditions. CMS introduced 2 new codes in the 2020 Physician Fee Schedule under the Principal Care Management Program.
– Billing Footnotes!
For new patients and patients not seen within a year prior to initiation of PCM, the billing practitioner must conduct an initiating visit with the patient in order to educate the patient on PCM and obtain the patient’s informed consent.
Principal Care Management is billed once per calendar month by a provider. Multiple specialists may initiate the PCM program for one patient in order to manage different chronic conditions.
The focus of the care plan must be one complex chronic condition lasting at least 3 months. CMS requires billing practitioners to record and maintain the structured care coordination electronically through the practice EHR.
Principal Care Management can be billed along with other telehealth programs such as Remote Patient Monitoring, however only Chronic Care Management or Principal Care Management can be billed in a calendar month.
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