Principal Care management Services (PCM)

In addition to the coding changes proposed to the existing CCM codes, CMS proposes a new Principal Care Management (PCM) payment and coding structure. This new service is in recognition of the considerable time needed to manage one complex chronic condition (vs. the 2+ chronic conditions covered by tradition CCM).

Principal Care management Services G Code GPP1

CPP1 is a new G Code proposed by CMS for a single high-risk disease. CPP1 requires at least 30 minutes of physician or other qualified health care professional time per calendar month with the following elements:

  • One complex chronic condition lasting at least 3 months, which is the focus of the care plan;
  • the condition is of sufficient severity to place patient at risk of hospitalization or have been the cause of a recent hospitalization;
  • the condition requires development or revision of 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.

Given that it requires “physician or other qualified health care professional time” CMS proposes a work RVU of 1.28.

Principal Care Management Services G Code GPP2

GPP2 is almost identical to GPP2, with the exception that the CCM 30+ minutes of care is “clinical staff time” directed by a physician or other qualified health care professional time per calendar month. GPP2 is the single disease equivalent to CPT 99490, while GPP3 maps to CPT 99491. Given this is “clinical staff time,” CMS proposes a work RVU of 0.61.