Amplify Your Revenue
Launched by CMS in 2020, Principal Care Management (PCM) allows providers to focus on a single chronic condition. At St. Vincent Preventative Family Care, we’re committed to helping your organization increase its PCM revenue.
Why PCM?
By focusing on a single condition, providers get to improve their quality of care.
By receiving disease-specific care, patients avoid exacerbation, comorbidities, and hospitalization.
With PCM, your organization:
- Gains additional revenue
- Drives down costs
- Boosts patient outcomes
Which Patients Are Eligible?
To receive PCM, a patient must meet the following criteria:
- They have at least one chronic condition
- Their provider expects the condition to last 3 months to 1 year, or until death
- Their condition has caused a recent hospitalization or significantly increases their risk of death, acute decompensation, or functional decline
- Their condition requires a specialist’s expertise
Before providing PCM, clinicians must document the patient’s consent in an EHR-certified health record.
Can Patients With Multiple Conditions Receive PCM?
Yes, but keep in mind:
- Only one clinician can bill for a single chronic condition.
- A clinician cannot bill for Chronic Care Management (CCM) and PCM at the same time.
- PCM has a time requirement of 30 minutes before it can be billed.
Can Rural Health Clinics and FQHCs Bill For PCM?
Yes. Simply use reimbursement code G0511.
HCPCS Code Descriptions
G2064– Comprehensive care management services for a single high-risk disease, e.g., Principal Care Management, 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 patient at risk of hospitalization or have been the cause of a recent
hospitalization,
▪ The condition requires development 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
G2065- Comprehensive care management for a single high-risk disease services, e.g. Principal Care Management, at
least 30 minutes of clinical staff time directed by a physician or other qualified health care 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 patient at risk of hospitalization or have been the cause of a recent
hospitalization,
▪ The condition requires development 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
In 2020, the payment rates for the two PCM codes were $92.03 (for G2064) and $39.70 (for G2065).