Principal Care Management in California.
Focused management of a single high-complexity chronic condition. Medicare billing, Medi-Cal coverage, and compliance details for California providers.
How does PCM work for providers in California?
Principal Care Management (PCM) allows California providers to bill Medicare for focused management of a single high-complexity chronic condition using CPT codes 99424, 99425, 99426, 99427. Medicare covers PCM under the same framework as CCM. Medi-Cal provides full supplementary coverage. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing for California practices.
Medicare Billing
PCM billing in California.
PCM uses federally standardized CPT codes with uniform reimbursement across California. Medi-Cal provides full supplementary Medicaid coverage for dual-eligible patients.
PCM services, first 30 min of clinical staff time per month
Each additional 30 min of PCM clinical staff time
PCM services requiring physician/QHP, first 30 min/month
Each additional 30 min of PCM physician/QHP time
~$75-$115/mo per patient
30 minutes of clinical staff or physician time per month for management of a single high-complexity condition
Medicare covers PCM under the same framework as CCM. Medi-Cal provides full supplementary coverage.
Billing Requirements
Patient must have a single high-complexity chronic condition
Condition requires frequent medication or treatment adjustment
Cannot be billed simultaneously with CCM (99490/99491)
Comprehensive care plan required for the principal condition
Patient consent required prior to billing
Regulatory Landscape
PCM compliance in California.
Beyond federal Medicare requirements, California has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *California has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *California has comprehensive telehealth parity laws. RPM is reimbursed at in-person rates for most payers.
Interstate Licensure
- *California is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid California medical license.
State Privacy Law
- *CCPA/CPRA applies to condition-specific treatment records managed under PCM programs.
- *Medication management records and care plan data must comply with both HIPAA and CCPA/CPRA.
Additional Requirements
- *California Consumer Privacy Act compliance required
- *Enhanced patient consent requirements
EHR Integrations
PCM-compatible EHRs.
CCN Health integrates with leading EHR platforms used by California providers. Each integration includes automated PCM documentation, billing, and clinical workflows.
PointClickCare
889 integration guides
ALIS
887 integration guides
Ethizo
240 integration guides
athenahealth
240 integration guides
Charm Health
240 integration guides
MatrixCare
240 integration guides
Epic
240 integration guides
August Health
240 integration guides
FAQ
PCM in California questions.
PCM in California uses Medicare CPT codes 99424, 99425, 99426, 99427. These are federal codes with uniform reimbursement nationwide, generating ~$75-$115/mo per patient per enrolled patient per month.
Medi-Cal provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Medi-Cal provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
California has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. California has comprehensive telehealth parity laws. RPM is reimbursed at in-person rates for most payers.
PCM in California focuses on a single high-complexity chronic condition requiring frequent medication or treatment adjustments (e.g., uncontrolled diabetes or complex heart failure). Unlike CCM, PCM does not require two or more conditions. PCM and CCM cannot be billed for the same patient in the same month.
California has approximately 6.5M residents aged 65+ (16.4% of the population), with +23% by 2035 projected growth. Largest Medicare market in the US. Strong telehealth adoption in urban areas. Medi-Cal expansion provides broad coverage for dual-eligible populations.
CCN Health helps California providers launch PCM in three steps: (1) Discovery — we assess your EHR, workflows, and patient population; (2) Launch — devices ship to patients, data flows into your EHR automatically; (3) Scale — expand enrollment and add programs as your PCM census grows. Most practices begin billing within 2-4 weeks.
Other Programs
More programs in California.
Explore other Medicare remote care programs available to California providers.
RPM
Remote Patient Monitoring
Real-time vital sign monitoring with FDA-cleared cellular devices.
CCM
Chronic Care Management
Non-face-to-face care coordination for patients with multiple chronic conditions.
BHI
Behavioral Health Integration
Behavioral health screening and collaborative care in primary care settings.
RTM
Remote Therapeutic Monitoring
Therapy outcome monitoring for musculoskeletal and respiratory rehabilitation.