{"id":15494,"date":"2022-06-22T13:33:13","date_gmt":"2022-06-22T13:33:13","guid":{"rendered":"https:\/\/www.medicalbillersandcoders.com\/blog\/?p=15494"},"modified":"2026-05-11T14:48:48","modified_gmt":"2026-05-11T14:48:48","slug":"2022-revised-codes-for-principal-care-management","status":"publish","type":"post","link":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/","title":{"rendered":"2022 Revised Codes for Principal Care Management"},"content":{"rendered":"<p class=\"ai-optimize-6 ai-optimize-introduction\"><span style=\"font-weight: 400;\">In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. <\/span><\/p>\n<p class=\"ai-optimize-6 ai-optimize-introduction\"><span style=\"font-weight: 400;\">These codes are like chronic care management services in that the work involves the establishment, implementation, revision, and monitoring of a care plan for a patient. However, principal care management focuses on a single condition (rather than two or more). In the year 2022, Medicare will accept CPT codes 99424, 99425, 99426, and 99427, and discontinue HCPCS codes G2064 and G2065.<\/span><\/p>\n<h2 class=\"ai-optimize-7\"><span style=\"font-weight: 400;\">2022 Revised Codes for Principal Care Management<\/span><\/h2>\n<p class=\"ai-optimize-8\"><span style=\"font-weight: 400;\"><strong>CPT 99424:<\/strong> Principal care management services, for a single high-risk disease, with the following, required elements:<\/span><\/p>\n<ul>\n<li class=\"ai-optimize-9\" style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">one complex chronic condition expected to last at least 3 months, and that places the patient at\u00a0<\/span><\/li>\n<li class=\"ai-optimize-10\" style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">significant risk of hospitalization, acute exacerbation\/ decompensation, functional decline, or death,\u00a0<\/span><\/li>\n<li class=\"ai-optimize-11\" style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">the condition requires development, monitoring, or revision of a 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,\u00a0<\/span><\/li>\n<li class=\"ai-optimize-12\" style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">ongoing communication and care coordination between relevant practitioners furnishing care.\u00a0<\/span><\/li>\n<\/ul>\n<p class=\"ai-optimize-13\"><span style=\"font-weight: 400;\">The first 30 minutes are provided personally by a <\/span><i><span style=\"font-weight: 400;\">physician or other qualified health care professional<\/span><\/i><span style=\"font-weight: 400;\">, per calendar month. The reimbursement rate for CPT 99424 in the year 2022 is $81.\u00a0<\/span><\/p>\n<p class=\"ai-optimize-14\"><span style=\"font-weight: 400;\"><strong>CPT 99425:<\/strong> For <\/span><i><span style=\"font-weight: 400;\">each<\/span><\/i> <i><span style=\"font-weight: 400;\">additional 30 minutes<\/span><\/i><span style=\"font-weight: 400;\"> provided personally by a physician or other qualified health care professional, per calendar month (List separately in addition to code for primary procedure. The reimbursement rate for CPT 99424 + 99425 in the year 2022 is $139.<\/span><\/p>\n<p class=\"ai-optimize-15\"><span style=\"font-weight: 400;\"><strong>CPT 99426:<\/strong> Principal care management services, for a single\u2026\u2026. between relevant practitioners furnishing care. The first 30 minutes of <\/span><i><span style=\"font-weight: 400;\">clinical staff time are directed by the physician or other qualified health care professional<\/span><\/i><span style=\"font-weight: 400;\">, per calendar month. The reimbursement rate for CPT 99426 in the year 2022 is $61.<\/span><\/p>\n<p class=\"ai-optimize-16\"><span style=\"font-weight: 400;\"><strong>CPT 99427:<\/strong> For <\/span><i><span style=\"font-weight: 400;\">each additional 30 minutes<\/span><\/i><span style=\"font-weight: 400;\"> of clinical staff time directed by a physician or other qualified health care professional per calendar month (List separately in addition to code for primary procedure. The reimbursement rate for CPT 99426 + 99427 in the year 2022 is $108.<\/span><\/p>\n<h2 class=\"ai-optimize-17\"><span style=\"font-weight: 400;\">PCM Vs CCM<\/span><\/h2>\n<p class=\"ai-optimize-18\"><span style=\"font-weight: 400;\">Principal care management (PCM) works much like chronic care management (CCM). Both programs help address chronic illness, but PCM is focused on treating only one, sole issue. To qualify for PCM, the patient must have a diagnosis that is expected to last between three months to a year or is life-long. <\/span><\/p>\n<p class=\"ai-optimize-18\"><span style=\"font-weight: 400;\">The condition must be associated with recent hospitalization, and\/or place the patient at significant risk of death, acute exacerbation or decompensation, or in a state of functional decline. For your patient to participate in PCM, they must provide written or verbal consent, which in turn must be documented by your practice. <\/span><\/p>\n<p class=\"ai-optimize-18\"><span style=\"font-weight: 400;\">Another key difference between PCM and CCM is the time required for billing. While CCM has a 20-minute requirement, PCM has a 30-minute requirement before it can be billed.<\/span><\/p>\n<h3 class=\"ai-optimize-19\">About Medical Billers and Coders<\/h3>\n<p class=\"ai-optimize-20\"><span style=\"font-weight: 400;\">For a detailed understanding of billing for Chronic Care Management Services, you can refer <\/span><a href=\"https:\/\/www.cms.gov\/outreach-and-education\/medicare-learning-network-mln\/mlnproducts\/downloads\/eval-mgmt-serv-guide-icn006764.pdf\"><span style=\"font-weight: 400;\">MLN document<\/span><\/a><span style=\"font-weight: 400;\">. <\/span><b>Medical Billers and Coders (MBC)<\/b><span style=\"font-weight: 400;\"> is a leading medical billing company providing complete <a href=\"https:\/\/www.medicalbillersandcoders.com\/revenue-management-services.aspx\">revenue cycle services<\/a>. <\/span><\/p>\n<p class=\"ai-optimize-20\"><span style=\"font-weight: 400;\">We can assist you in receiving accurate insurance reimbursements for Chronic Care Management (CCM) and Principal Care Management (PCM). To learn more about our medical billing and coding services, contact us at <a href=\"mailto:info@medicalbillersandcoders.com\">info@medicalbillersandcoders.com<\/a>\/ <a href=\"tel:888-357-3226\">888-357-3226<\/a><\/span><\/p>\n<h2 class=\"ai-optimize-21\">FAQs<\/h2>\n\n\n<div class=\"schema-faq wp-block-yoast-faq-block\"><div class=\"schema-faq-section\" id=\"faq-question-1749802027832\"><strong class=\"schema-faq-question\"><strong>1. What are the new CPT codes introduced for Principal Care Management (PCM) in 2022?<\/strong><\/strong> <p class=\"schema-faq-answer\">In 2022, Medicare introduced new CPT codes for Principal Care Management (PCM): 99424, 99425, 99426, and 99427. These codes replaced HCPCS codes G2064 and G2065 and focus on managing a single high-risk chronic condition that requires ongoing monitoring and care coordination.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1749802042027\"><strong class=\"schema-faq-question\"><strong>2. How does Principal Care Management (PCM) differ from Chronic Care Management (CCM)?<\/strong><\/strong> <p class=\"schema-faq-answer\">While both PCM and CCM address chronic illnesses, PCM is specific to managing a single high-risk condition, whereas CCM involves managing two or more chronic conditions. PCM requires a 30-minute time threshold for billing, compared to CCM\u2019s 20-minute requirement.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1749802055358\"><strong class=\"schema-faq-question\"><strong>3. What is the reimbursement rate for CPT 99424 and 99425 for Principal Care Management in 2022?<\/strong><\/strong> <p class=\"schema-faq-answer\">In 2022, CPT code 99424 (for the first 30 minutes of care provided personally by a physician or qualified healthcare professional) is reimbursed at $81. For each additional 30 minutes (CPT 99425), the reimbursement rate is $58, making the total $139 for 99424 + 99425.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1749802067974\"><strong class=\"schema-faq-question\"><strong>4. What are the requirements to bill CPT 99426 and 99427 for PCM services provided by clinical staff?<\/strong><\/strong> <p class=\"schema-faq-answer\">CPT 99426 covers the first 30 minutes of PCM services provided by clinical staff under the direction of a physician, with a reimbursement rate of $61 in 2022. CPT 99427 covers each additional 30 minutes and is reimbursed at $47, totaling $108 for 99426 + 99427.<\/p> <\/div> <div class=\"schema-faq-section\" id=\"faq-question-1749802080261\"><strong class=\"schema-faq-question\"><strong>5. What are the patient qualifications to enroll in Principal Care Management (PCM) services?<\/strong><\/strong> <p class=\"schema-faq-answer\">To qualify for PCM, a patient must have a high-risk condition expected to last at least 3 months and place the patient at significant risk of hospitalization, exacerbation, or functional decline. The patient must provide verbal or written consent, which must be documented by the practice.<\/p> <\/div> <\/div>\n","protected":false},"excerpt":{"rendered":"<p>In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing codes in the same categories. These codes are [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":15495,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[2796,80,81,3102,162,3342,3483,187,3479],"class_list":["post-15494","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medical-billing-services","tag-accurate-insurance-reimbursements","tag-cpt-codes","tag-hcpcs-codes","tag-leading-medical-billing-company","tag-medical-billing-and-coding-services","tag-medicare-physician-fee-schedule-mpfs","tag-pcm-vs-ccm","tag-physician","tag-principal-care-management"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.9 (Yoast SEO v27.9) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>2022 Revised Codes for Principal Care Management<\/title>\n<meta name=\"description\" content=\"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"2022 Revised Codes for Principal Care Management\" \/>\n<meta property=\"og:description\" content=\"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/\" \/>\n<meta property=\"og:site_name\" content=\"Medical Billing and RCM Blogs\" \/>\n<meta property=\"article:published_time\" content=\"2022-06-22T13:33:13+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2026-05-11T14:48:48+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"748\" \/>\n\t<meta property=\"og:image:height\" content=\"288\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Debbie Young\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Debbie Young\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":[\"Article\",\"BlogPosting\"],\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/\"},\"author\":{\"name\":\"Debbie Young\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#\\\/schema\\\/person\\\/7f342d78435e4c2aca762f4fc26559fe\"},\"headline\":\"2022 Revised Codes for Principal Care Management\",\"datePublished\":\"2022-06-22T13:33:13+00:00\",\"dateModified\":\"2026-05-11T14:48:48+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/\"},\"wordCount\":816,\"publisher\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/06\\\/2022-Revised-Codes-for-Principal-Care-Management.jpg\",\"keywords\":[\"accurate insurance reimbursements\",\"CPT codes\",\"HCPCS Codes\",\"leading medical billing company\",\"medical billing and coding services\",\"Medicare Physician Fee Schedule (MPFS)\",\"PCM Vs CCM\",\"physician\",\"Principal Care Management\"],\"articleSection\":[\"Medical Billing Services\"],\"inLanguage\":\"en-US\",\"copyrightYear\":\"2022\",\"copyrightHolder\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\"}},{\"@type\":[\"WebPage\",\"FAQPage\"],\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/\",\"name\":\"2022 Revised Codes for Principal Care Management\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/06\\\/2022-Revised-Codes-for-Principal-Care-Management.jpg\",\"datePublished\":\"2022-06-22T13:33:13+00:00\",\"dateModified\":\"2026-05-11T14:48:48+00:00\",\"description\":\"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#breadcrumb\"},\"mainEntity\":[{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802027832\"},{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802042027\"},{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802055358\"},{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802067974\"},{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802080261\"}],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#primaryimage\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/06\\\/2022-Revised-Codes-for-Principal-Care-Management.jpg\",\"contentUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2022\\\/06\\\/2022-Revised-Codes-for-Principal-Care-Management.jpg\",\"width\":748,\"height\":288,\"caption\":\"2022 Revised Codes for Principal Care Management\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"2022 Revised Codes for Principal Care Management\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#website\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/\",\"name\":\"Medical Billing and RCM Blogs\",\"description\":\"Medical Billing and Coding Services in USA\",\"publisher\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\"},\"alternateName\":\"MBC\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":[\"Organization\",\"Place\",\"ProfessionalService\"],\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#organization\",\"name\":\"Medical Billers and Coders\",\"alternateName\":\"MBC\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2025\\\/04\\\/MBC-Square-Logo.png\",\"contentUrl\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/wp-content\\\/uploads\\\/2025\\\/04\\\/MBC-Square-Logo.png\",\"width\":512,\"height\":512,\"caption\":\"Medical Billers and Coders\"},\"image\":{\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"telephone\":[\"888-357-3226\"],\"contactPoint\":{\"@type\":\"ContactPoint\",\"telephone\":\"888-357-3226\",\"email\":\"info@medicalbillersandcoders.com\"},\"email\":\"sales@medicalbillersandcoders.com\",\"faxNumber\":\"888-316-4566\",\"currenciesAccepted\":\"$\",\"openingHoursSpecification\":[{\"@type\":\"OpeningHoursSpecification\",\"dayOfWeek\":[\"Monday\",\"Tuesday\",\"Wednesday\",\"Thursday\",\"Friday\"],\"opens\":\"08:00\",\"closes\":\"17:00\"},{\"@type\":\"OpeningHoursSpecification\",\"dayOfWeek\":[\"Saturday\",\"Sunday\"],\"opens\":\"00:00\",\"closes\":\"00:00\"}]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/#\\\/schema\\\/person\\\/7f342d78435e4c2aca762f4fc26559fe\",\"name\":\"Debbie Young\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g\",\"caption\":\"Debbie Young\"},\"description\":\"A Subject Matter Expert in healthcare billing operations with nearly 10 years of experience, sharing insights on claims processing, coding support, and revenue cycle optimization. Dedicated to educating healthcare professionals on compliance, accuracy, and strategies to improve billing performance.\",\"sameAs\":[\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/\",\"https:\\\/\\\/www.linkedin.com\\\/in\\\/debbie-young-4544a631a\\\/\"]},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802027832\",\"position\":1,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802027832\",\"name\":\"1. What are the new CPT codes introduced for Principal Care Management (PCM) in 2022?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"In 2022, Medicare introduced new CPT codes for Principal Care Management (PCM): 99424, 99425, 99426, and 99427. These codes replaced HCPCS codes G2064 and G2065 and focus on managing a single high-risk chronic condition that requires ongoing monitoring and care coordination.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802042027\",\"position\":2,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802042027\",\"name\":\"2. How does Principal Care Management (PCM) differ from Chronic Care Management (CCM)?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"While both PCM and CCM address chronic illnesses, PCM is specific to managing a single high-risk condition, whereas CCM involves managing two or more chronic conditions. PCM requires a 30-minute time threshold for billing, compared to CCM\u2019s 20-minute requirement.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802055358\",\"position\":3,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802055358\",\"name\":\"3. What is the reimbursement rate for CPT 99424 and 99425 for Principal Care Management in 2022?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"In 2022, CPT code 99424 (for the first 30 minutes of care provided personally by a physician or qualified healthcare professional) is reimbursed at $81. For each additional 30 minutes (CPT 99425), the reimbursement rate is $58, making the total $139 for 99424 + 99425.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802067974\",\"position\":4,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802067974\",\"name\":\"4. What are the requirements to bill CPT 99426 and 99427 for PCM services provided by clinical staff?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"CPT 99426 covers the first 30 minutes of PCM services provided by clinical staff under the direction of a physician, with a reimbursement rate of $61 in 2022. CPT 99427 covers each additional 30 minutes and is reimbursed at $47, totaling $108 for 99426 + 99427.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"},{\"@type\":\"Question\",\"@id\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802080261\",\"position\":5,\"url\":\"https:\\\/\\\/www.medicalbillersandcoders.com\\\/blog\\\/2022-revised-codes-for-principal-care-management\\\/#faq-question-1749802080261\",\"name\":\"5. What are the patient qualifications to enroll in Principal Care Management (PCM) services?\",\"answerCount\":1,\"acceptedAnswer\":{\"@type\":\"Answer\",\"text\":\"To qualify for PCM, a patient must have a high-risk condition expected to last at least 3 months and place the patient at significant risk of hospitalization, exacerbation, or functional decline. The patient must provide verbal or written consent, which must be documented by the practice.\",\"inLanguage\":\"en-US\"},\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO Premium plugin. -->","yoast_head_json":{"title":"2022 Revised Codes for Principal Care Management","description":"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/","og_locale":"en_US","og_type":"article","og_title":"2022 Revised Codes for Principal Care Management","og_description":"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,","og_url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/","og_site_name":"Medical Billing and RCM Blogs","article_published_time":"2022-06-22T13:33:13+00:00","article_modified_time":"2026-05-11T14:48:48+00:00","og_image":[{"width":748,"height":288,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg","type":"image\/jpeg"}],"author":"Debbie Young","twitter_card":"summary_large_image","twitter_misc":{"Written by":"Debbie Young","Est. reading time":"5 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":["Article","BlogPosting"],"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#article","isPartOf":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/"},"author":{"name":"Debbie Young","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#\/schema\/person\/7f342d78435e4c2aca762f4fc26559fe"},"headline":"2022 Revised Codes for Principal Care Management","datePublished":"2022-06-22T13:33:13+00:00","dateModified":"2026-05-11T14:48:48+00:00","mainEntityOfPage":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/"},"wordCount":816,"publisher":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#organization"},"image":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#primaryimage"},"thumbnailUrl":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg","keywords":["accurate insurance reimbursements","CPT codes","HCPCS Codes","leading medical billing company","medical billing and coding services","Medicare Physician Fee Schedule (MPFS)","PCM Vs CCM","physician","Principal Care Management"],"articleSection":["Medical Billing Services"],"inLanguage":"en-US","copyrightYear":"2022","copyrightHolder":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#organization"}},{"@type":["WebPage","FAQPage"],"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/","url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/","name":"2022 Revised Codes for Principal Care Management","isPartOf":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#primaryimage"},"image":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#primaryimage"},"thumbnailUrl":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg","datePublished":"2022-06-22T13:33:13+00:00","dateModified":"2026-05-11T14:48:48+00:00","description":"Learn about Principal Care Management (PCM) and new CPT codes for reimbursement. Improve care for high-risk patients,","breadcrumb":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#breadcrumb"},"mainEntity":[{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802027832"},{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802042027"},{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802055358"},{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802067974"},{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802080261"}],"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#primaryimage","url":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg","contentUrl":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2022\/06\/2022-Revised-Codes-for-Principal-Care-Management.jpg","width":748,"height":288,"caption":"2022 Revised Codes for Principal Care Management"},{"@type":"BreadcrumbList","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.medicalbillersandcoders.com\/blog\/"},{"@type":"ListItem","position":2,"name":"2022 Revised Codes for Principal Care Management"}]},{"@type":"WebSite","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#website","url":"https:\/\/www.medicalbillersandcoders.com\/blog\/","name":"Medical Billing and RCM Blogs","description":"Medical Billing and Coding Services in USA","publisher":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#organization"},"alternateName":"MBC","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.medicalbillersandcoders.com\/blog\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":["Organization","Place","ProfessionalService"],"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#organization","name":"Medical Billers and Coders","alternateName":"MBC","url":"https:\/\/www.medicalbillersandcoders.com\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#\/schema\/logo\/image\/","url":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2025\/04\/MBC-Square-Logo.png","contentUrl":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-content\/uploads\/2025\/04\/MBC-Square-Logo.png","width":512,"height":512,"caption":"Medical Billers and Coders"},"image":{"@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#\/schema\/logo\/image\/"},"telephone":["888-357-3226"],"contactPoint":{"@type":"ContactPoint","telephone":"888-357-3226","email":"info@medicalbillersandcoders.com"},"email":"sales@medicalbillersandcoders.com","faxNumber":"888-316-4566","currenciesAccepted":"$","openingHoursSpecification":[{"@type":"OpeningHoursSpecification","dayOfWeek":["Monday","Tuesday","Wednesday","Thursday","Friday"],"opens":"08:00","closes":"17:00"},{"@type":"OpeningHoursSpecification","dayOfWeek":["Saturday","Sunday"],"opens":"00:00","closes":"00:00"}]},{"@type":"Person","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/#\/schema\/person\/7f342d78435e4c2aca762f4fc26559fe","name":"Debbie Young","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/40b4c58ac43c1596ef9bf096a64133ac98e3f11f98a1369787896fb6feee302d?s=96&d=mm&r=g","caption":"Debbie Young"},"description":"A Subject Matter Expert in healthcare billing operations with nearly 10 years of experience, sharing insights on claims processing, coding support, and revenue cycle optimization. Dedicated to educating healthcare professionals on compliance, accuracy, and strategies to improve billing performance.","sameAs":["https:\/\/www.medicalbillersandcoders.com\/","https:\/\/www.linkedin.com\/in\/debbie-young-4544a631a\/"]},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802027832","position":1,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802027832","name":"1. What are the new CPT codes introduced for Principal Care Management (PCM) in 2022?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"In 2022, Medicare introduced new CPT codes for Principal Care Management (PCM): 99424, 99425, 99426, and 99427. These codes replaced HCPCS codes G2064 and G2065 and focus on managing a single high-risk chronic condition that requires ongoing monitoring and care coordination.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802042027","position":2,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802042027","name":"2. How does Principal Care Management (PCM) differ from Chronic Care Management (CCM)?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"While both PCM and CCM address chronic illnesses, PCM is specific to managing a single high-risk condition, whereas CCM involves managing two or more chronic conditions. PCM requires a 30-minute time threshold for billing, compared to CCM\u2019s 20-minute requirement.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802055358","position":3,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802055358","name":"3. What is the reimbursement rate for CPT 99424 and 99425 for Principal Care Management in 2022?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"In 2022, CPT code 99424 (for the first 30 minutes of care provided personally by a physician or qualified healthcare professional) is reimbursed at $81. For each additional 30 minutes (CPT 99425), the reimbursement rate is $58, making the total $139 for 99424 + 99425.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802067974","position":4,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802067974","name":"4. What are the requirements to bill CPT 99426 and 99427 for PCM services provided by clinical staff?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"CPT 99426 covers the first 30 minutes of PCM services provided by clinical staff under the direction of a physician, with a reimbursement rate of $61 in 2022. CPT 99427 covers each additional 30 minutes and is reimbursed at $47, totaling $108 for 99426 + 99427.","inLanguage":"en-US"},"inLanguage":"en-US"},{"@type":"Question","@id":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802080261","position":5,"url":"https:\/\/www.medicalbillersandcoders.com\/blog\/2022-revised-codes-for-principal-care-management\/#faq-question-1749802080261","name":"5. What are the patient qualifications to enroll in Principal Care Management (PCM) services?","answerCount":1,"acceptedAnswer":{"@type":"Answer","text":"To qualify for PCM, a patient must have a high-risk condition expected to last at least 3 months and place the patient at significant risk of hospitalization, exacerbation, or functional decline. The patient must provide verbal or written consent, which must be documented by the practice.","inLanguage":"en-US"},"inLanguage":"en-US"}]}},"_links":{"self":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15494","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/comments?post=15494"}],"version-history":[{"count":6,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15494\/revisions"}],"predecessor-version":[{"id":24921,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/posts\/15494\/revisions\/24921"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media\/15495"}],"wp:attachment":[{"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/media?parent=15494"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/categories?post=15494"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medicalbillersandcoders.com\/blog\/wp-json\/wp\/v2\/tags?post=15494"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}