CMS has extended chronic care management services for patients with one (1) serious and high-risk chronic condition in order to extend benefits of the CCM program to a wider population.
This new program, Principal Chronic Management (PCM), will give specialists greater opportunities to provide chronic care management to their patients. By creating a program for patients with only one (1) complex condition, CMS is recognizing the work many specialists and primary care providers give to their high-risk and complex care patients.
The parameters of the program are similar to CCM with the following differences:
- One (1) complex condition lasting at least three (3) months
- The care plan is focused on the complex condition
- Condition requires creation or revision of a disease-specific care plan
- Higher Relative Value Unit (RVU)
- 30-minutes of services
- The condition requires frequent adjustments in the medication regimen, and/or the management of the condition is unusually complex due to comorbidities.
- G2064 can be billed for services provided by a physician or other qualified health care professional
- G2065 can be billed for services provided by clinical staff, directed by a physician or other qualified health care professional