Principal Care Management

What it is

Principal Care Management (PCM) is a Medicare benefit for patients with a single complex chronic condition that places them at risk of decompensation, acute exacerbation, or functional decline. PCM differs from CCM in that PCM focuses on the management of one condition, often by a specialist — a cardiology HF panel, a nephrology CKD panel, an endocrinology T2DM panel.

Billed monthly in 30-minute tiers.

Who qualifies

• Patient has one complex chronic condition expected to last ≥ 3 months, with a high risk of decompensation, hospitalization, or functional decline.
• Care is provided by a single practitioner or care team focused on that condition.
• Patient consent on file.
• Disease-specific care plan exists and is accessible to the patient + team.
• May be billed concurrently with CCM by a different practitioner (e.g., specialist bills PCM while PCP bills CCM) when the two manage different conditions; the same practitioner never bills both in a month.
• Not billed with APCM under the same practitioner; willowbridge's enrollment does not currently allow PCM beside an active APCM enrollment.

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 directed by a physician or QHCP, per calendar month — clinical staff PCM.
  Requirements≥ 30 minutes of staff and provider time combined; signed care plan; consent on file.
• 99427Each additional 30 minutes of clinical staff time (use with 99426).
  RequirementsAdd-on to 99426; willowbridge bills one per month, at 60 minutes.
• 99424First 30 minutes of PCM personally performed by the billing physician or QHCP.
  RequirementsPractitioner's own time only. Cannot combine with 99426 or 99427 in the same month.
• 99425Each additional 30 minutes personally performed (use with 99424).
  RequirementsAdd-on to 99424; willowbridge bills one per month, at 60 minutes.

Documentation required every cycle

Each calendar month must show:

1. Total clinical staff or practitioner time spent on PCM (rounded to the minute).
2. Condition-specific care plan documenting the focused intervention.
3. Care coordination with the patient's PCP and other treating clinicians.
4. Patient consent on file with version, date, and capture method.
5. Signed care plan — the month does not bill without one; for a condition with a care pathway (heart failure, type 2 diabetes, CKD, hypertension, COPD, atrial fibrillation), the owning provider signs the pathway, renewed every 6 months.
6. Practitioner sign-off at month close.

What's new in CY 2026

CY 2026 retains the PCM code set. PCM can bill in the same month as CCM only when a different practitioner bills it for a different condition; the same practitioner never bills both for a patient in the same month.

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.