Principal Care Management

This new Medicare program for 2020, open to specialists and primary care providers, provides a timely supplement to telehealth for your sickest patients.

Lost in all that Medicare is doing to support providers and beneficiaries during the COVID-19 pandemic, the Principal Care Management program launched on 1/1/2020 is a valuable cousin to Chronic Care Management (CCM).

Similar to CCM, with time-based care coordination throughout the month (that can be provided remotely), Principal Care Management provides reimbursement for time spent managing a patient’s single high-risk condition that:

  • Onset at least 3 months prior 
  • Has resulted in recent hospitalization or likely to result in hospitalization
  • Requires development or revision of disease-specific care plan
  • Requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.

These services are billable under two new codes, G2064 (physician or other qualified health care provider time) or G2065 (clinical staff time).

Similar to CCM, providers billing for PCM will want to ensure that patient communication is adequately documented, including but not limited to:

  1. The patient’s verbal agreement to participate
  2. Documentation of the applicable disease attributes above
  3. The patient’s care plan and adjustments
  4. Description of services provided 
  5. Time spent each time services are provided

Key contributor: Many thanks to Julie Miller, CEO, and President of Vital Healthcare Solutions, for her contributions to the content of this Blog.