HealthArc's Integrated Approach to Principal Care Management enables providers to deliver care to patients suffering from single chronic condition by enhancing the quality metrics of their healthcare.

47% Approximately 47 percent of the population in the United States suffers from at least one chronic condition.​

7/10 Chronic diseases are responsible for 7 out of every 10 deaths in the U.S., killing more than 1.7 million Americans every year.

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Effective care plan creation with EHR Integration

Create, modify, and update patient-centered care plans with ease. HealthArc connects easily with the market’s top 55 EHRs. Aside from EHRs, HealthArc can interact with any device that supports external APIs, such as Bluetooth or cellular devices.

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Clinician-friendly software that supports multiple conditions

Our PCM software solution automates workflows to simplify time-consuming tasks, minimizing staff burnout. HealthArc is designed to enhance the health standards and help you meet the needs of patients holistically with robust mechanisms to analyse respiratory system status, musculoskeletal system status and therapy adherence.

10000+ live patients on the platform
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Enhances Clinical Decision Support

HealthArc has a dedicated Security & Compliance team to guarantee that privacy is built into our people, systems, and third-party relationships. All of our components, including the patient engagement module, are HIPAA compliant, including SMS and in-app messaging.

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Concurrent Billing with Other Services (RPM) and (CCM)

The HealthArc platform enables providers to deliver care management services for Remote Patient Monitoring (RPM), Chronic Care Management (for multiple patients) (CCM), and Virtual Visits at the same time. Remote Patient Monitoring can be invoiced at the same time as principal care management as long as the time is not billed twice

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CMS rules for its new Principal Care Management (PCM) codes 2023

CMS has released the final rules for its new Principal Care Management (PCM) codes, formally known as “Remote Medical Monitoring/Treatment Management,” for the 2023 Physician Fee Schedule (PFS). Five PCM codes became effective from January 1, 2023

Associated CPT Codes by CMS Principal Care Management

CPT Code 99424

The first 30 minutes of a Principal Care Management service per calendar month provided by a physician or qualified healthcare professional.

Average payment – $97
CPT Code 99425

To capture each additional 30 minutes of service in addition to 99424, CPT code 99425 would be reported.

Average payment – $71
CPT Code 99426

This covers the first 30 minutes of PCM clinical staff time, as carried out by clinical staff (such as nursing professionals) under the direction and guidance of a physician or QHCP.

Average payment – $74
CPT Code 99427

It involves additional 30 minutes of PCM clinical staff time, as carried out by clinical staff (such as nursing professionals) under the direction and guidance of a physician or QHCP.

Average payment – $57
** – Payments vary with subject to specific locations- Please refer cms.gov

Frequently Asked Questions

What is principal care management?

Fundamentally, principal care management is a model for the care of patients with a chronic illness for a period lasting three or more months. According to the CMS definition (via the AACP), the patient must also have had either a recent hospitalization or an acute risk of death, exacerbation or functional decline, or require management that’s “unusually complex due to comorbidities.”

What are the Principal Care Management (PCM) CPT Codes?

Principal Care Management (PCM) utilizes CPT codes 99424 and 99425 for the Physician/NPP's initial 30 minutes and additional 30 minutes, respectively. It also employs 99426 and 99427 to document and bill for the clinical staff's time of 30 minutes and each incremental 30 minutes, respectively, dedicated to supporting patients with specific chronic conditions. These codes facilitate meticulous tracking of patient care, ensuring individuals receive personalized attention and comprehensive management to navigate their health challenges effectively.

Key Requirements for Billing the Principal Care Management (PCM) CPT Codes

The key requirements include:

  • Checking patients' eligibility for PCM and receiving patient consents.
  • Patients need a single, serious, and complex chronic condition.
  • Providers/Clinical Staff meet monthly time thresholds (30 minutes and additional 30 minutes), documenting care plans and staff involvement.
  • Accurate coding and detailed documentation are essential.

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