Principal Care Management

What it is

Principal Care Management (PCM) is a Medicare benefit for the management of one complex chronic condition — the patient's principal condition — expected to last at least 3 months, that places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death, and needs a disease-specific care plan. It is often a specialist's service — a cardiology heart-failure panel, a nephrology CKD panel, an endocrinology diabetes panel.

Billed once per calendar month by one practitioner, in 30-minute steps; each claim is dated to the day its minutes were reached, with the principal condition first.

Who qualifies

• One principal condition, chosen on the enrollment from the care plan, with the practitioner's determination that it is expected to last at least 3 months and places the patient at significant risk.
• A disease-specific plan for it: a goal under it on the signed care plan, or — for heart failure, type 2 diabetes, CKD, hypertension, COPD and atrial fibrillation — its care pathway signed by the practitioner, with an intervention worked.
• Consent to PCM from the billing practitioner, with the moment the patient agreed, and the initiating visit (as for CCM; PCM is not re-initiated every year).
• Only one practitioner bills PCM for a patient in a month. Another practitioner may bill CCM for different conditions; the same practitioner never bills PCM beside their own CCM, APCM, TCM, BHI or chronic pain management in the same month.
• A missing piece holds the month until it is recorded; nothing logged is lost.

Codes & when to bill them

Each billable code, with the requirements that must be on file to bill it.

• 99426First 30 minutes of clinical staff time (with the billing practitioner's own time), per calendar month.
  Requirements30 or more counted minutes on the principal condition; its disease-specific plan; the consent for this practitioner; the initiating visit.
• 99427Each additional 30 minutes of clinical staff time (use with 99426).
  RequirementsAdd-on to 99426 on the same claim and date; up to two (60 and 90 minutes).
• 99424First 30 minutes of PCM personally performed by the billing physician or qualified practitioner.
  RequirementsOnly the practitioner's own minutes count; staff entries are listed and not counted.
• 99425Each additional 30 minutes personally performed (use with 99424).
  RequirementsAdd-on to 99424; up to two (60 and 90 minutes).

Documentation required every cycle

Each calendar month's billing note prints the month's frozen record:

1. The codes and why, the counted minutes by role, and every entry that did not count, with why.
2. The date of service and why — the day the 30th counted minute (or the last billed add-on) was reached.
3. The principal condition with the practitioner's determination, and the care pathway or plan it rests on.
4. Coordination with the patient's other treating practitioners, logged as its own activity.
5. The consent, the initiating visit and the care-plan version the month froze on.
6. The practitioner's signature: general supervision for 99426 / 99427, their own time on 99424 / 99425.

What's new in CY 2026

CY 2026: the PCM codes and descriptors are unchanged, and PCM is exempt from the 2026 efficiency adjustment. PCM can bill in the same month as CCM only when a different practitioner bills CCM for different conditions.

Built-in patient consentwillowbridge exclusive

Every program ships with compliant, CY-2026 patient consent language — read verbatim into the in-app consent capture flow, captured with date + modality, and version-pinned to each claim, so the consent on file always matches the consent that was billed. No more chasing signatures or re-papering when the rule changes.

Common questions

Related programs

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