In CPT this year, there are new Category I codes for Principal Care Management (PCM).
| CPT CODE | DESCRIPTION |
| #•99424 | Principal care management services, for a single high-risk disease…; first 30 minutes provided personally by a physician or OQHCP, per calendar month |
| #+•99425 | each additional 30 minutes provided personally by a physician or OQHCP, per calendar month |
| #•99426 | Principal care management services, for a single high-risk disease…; first 30 minutes of clinical staff time directed by a physician or OQHCP, per calendar month |
| #+•99427 | each additional 30 minutes of clinical staff time directed by a physician or OQHCP, per calendar month |
PCM are services that are given to a patient that focus on a single, complex, chronic medical and/or psychological condition expected to last at least 3 months. IT includes establishing, implementing, revising, or monitoring a care plan specific to that single condition. They are time-based codes as evidenced in the above table, and are broken down further by the provider of the service (physician/other qualified health care professional (OQHCP) or clinical staff and are reported once every calendar month.
Here are the required elements:
- One complex chronic condition expected to last at least 3 months, and places the patient at significant risk of hospitalization, acute exacerbation/decompensation, functional decline, or death,
- The condition requires development, monitoring, or revision of 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,
- Ongoing communication and care coordination between relevant practitioners furnishing care.
NOTE: PCM services of less than 30 minutes in a calendar month are not separately reportable.
Look to page 68 of your CPT 2022 Professional Edition book for a table for help in reporting units.
Also, of importance to note is that CMS has stated that to report these services, an initiating visit and patient consent must be documented in the chart.
*This is based on information available as of 02/06/22.
