Collaborative Principal Care Management with Automated Care Plans and Guaranteed Reimbursement
Deliver collaborative care and easily get reimbursed for PCM services, helping patients with a single chronic illness stabilize and prevent potential exacerbations.
PCM program involves
Individual care planning
Prescription refills
Referrals to providers
Physician review
Why Choose healthviewX Principal Care Management?
With HealthViewX PCM, automatically generate care plans based on EHR data, identify eligible patients, and streamline enrollment, documentation, and billing for guaranteed CMS reimbursement, eliminating the hassle of traditional methods.
Reduced hospital/ER admissions
Reduced hospital/ER admissions
Increased services reimbursements
Improved patient satisfaction/outcome
Reduced unnecessary patient visits
Reduced patient healthcare costs
Eligibility Criteria for Patients
Patients covered by PCM codes must meet the following criteria defined by CMS
Concurrent Billing with Other Services (RPM) and (CCM):
HealthViewX empowers providers to manage Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Virtual Visits, while CMS’s Principal Care Management (PCM) extends care to patients with a single chronic condition, expanding coverage beyond CCM’s dual-condition criteria.
Remote Patient Monitoring
can be billed concurrently with principal care management as long as the time is not counted twice.
Chronic Care Management
cannot be billed concurrently with principal care management by the same billing practitioner.
Medicare Principal Care Management (PCM) Reimbursement Codes
The billing practitioner must be a physician or a qualified health care practitioner (QHCP). FQHCs/RHCs may bill for the PCM services under the G0511 care management code.
| Medicare Reimbursement Code | Description | Average Reimbursement/Month | Minimum Service Time/Month |
|---|---|---|---|
| CPT 99424 | The first 30 mins are provided personally by a physician or other QHCP | $81 per patient/month | 30 mins |
| CPT 99425 | For each additional 30 mins provided personally by a physician or other QHCP | $81 per patient/month | 30 mins |
| CPT 99426 | The first 30 mins of clinical staff time directed by the physician | $81 per patient/month | 30 mins |
| CPT 99427 | For each additional 30 mins of clinical staff time directed by the physician | $81 per patient/month | 30 mins |
*The 30 minutes of provider/clinical staff time does not have to be face-to-face time, but can be time used to create care plans, follow up with patients via phone, etc.
Learn how our PCM solution can elevate your practice by scheduling a no-obligation demo.
