2022 Coding Updates For Principal Care Management (PCM)

1
2022 Coding Updates For Principal Care Management
(PCM)
2
2022 Coding Updates For Principal Care Management
(PCM)
Basics of Principal Care Management (PCM) In the
Medicare Physician Fee Schedule final rule issued
in November 2021, the Centers for Medicare and
Medicaid Services (CMS) added four new CPT codes
(99424, 99425, 99426, and 99427) in the category
of Principal Care Management (PCM) to replace the
two previous PCM codes (HCPCS codes G2064 and
G2065). These new PCM codes are intended to
reimburse physicians for the additional work they
do caring for high risk, complex patients. This
includes the extra time and work required for
medication adjustments, creating a care plan,
patient follow-up and more. CMS is trying to
improve care for complicated PCM patients and
keep them out of the hospital, and it is willing
to pay physicians more to make that happen. PCM
Codes Description CPT 99424 PCM services for a
single high-risk disease, first 30 minutes,
provided personally by a physician or other
qualified health care professional, per calendar
month. (Medicare reimbursement rate for
non-facility 83.40) CPT 99425 PCM services
for a single high-risk disease, each additional
30 minutes, provided personally by a physician or
other qualified health care professional, per
calendar month. (Medicare reimbursement rate for
non-facility 60.22)
3
2022 Coding Updates For Principal Care Management
(PCM)
CPT 99426 PCM services for a single high-risk
disease, first 30 minutes of clinical staff time
directed by physician or other qualified health
care professional, per calendar month. (Medicare
reimbursement rate for non-facility
63.33) CPT 99427 PCM services for a single
high-risk disease, each additional 30 minutes of
clinical staff time directed by a physician or
other qualified health care professional, per
calendar month. (Medicare reimbursement rate for
non-facility 48.45) Note that, CPT codes
99424 and 99425 are for time spent by a physician
or other qualified health care professional. CPT
codes 99426 and 99427 are for clinical staff time
directed by a physician or other qualified health
care professional. Keep in mind,
provider/clinical staff time does not have to be
face-to-face time. It can be time used to create
care plans, follow-up with patients via phone,
etc. Coding updates for Principal Care
Management (PCM) shared in this article address
Medicare fee-for-service payment rules. For
private insurances, you can refer reimbursement
policy for verify coverage. Medisys Data
Solutions is a leading medical billing company
providing billing and coding services for various
medical billing specialities. If you need any
assistance in Medicare medical billing for your
practice, contact us at info_at_medisysdata.com/
302-261-9187
4
(No Transcript)