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. Prevalent conditions like diabetes drive PCM demand across California. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 6+ major health systems including Kaiser Permanente and Sutter Health. California's dense urban healthcare market supports strong adoption of remote care programs.
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
California Medicaid Supplement
Medi-Cal provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. California's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
California-Specific Billing Considerations
California Consumer Privacy Act compliance required
Enhanced patient consent requirements
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.
Major California health systems like Kaiser Permanente and Sutter Health use EHR platforms that CCN Health integrates with. Each integration includes automated PCM documentation, billing, and clinical workflows.
PointClickCare
665 integration guides
ALIS
663 integration guides
MatrixCare
663 integration guides
August Health
663 integration guides
Ethizo
240 integration guides
athenahealth
240 integration guides
Charm Health
240 integration guides
Epic
240 integration guides
FAQ
PCM in California questions.
California's dense healthcare market and 6+ major health systems like Kaiser Permanente and Sutter Health create strong infrastructure for PCM adoption. Medi-Cal provides full supplementary coverage, maximizing dual-eligible revenue. High prevalence of diabetes, heart disease, hypertension among California's patient population drives PCM enrollment.
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.
Among California's 6.5M seniors, patients with a single high-complexity condition — such as uncontrolled diabetes or advanced heart disease — are prime PCM candidates. California's urban practices often identify PCM candidates through existing chronic disease registries. California's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
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.
PCM in California must comply with federal Medicare billing requirements and HIPAA. California's CCPA/CPRA adds state-level data protection requirements for patient health information collected through PCM devices and platforms. California is not part of the Interstate Medical Licensure Compact — providers must hold a valid California license to deliver PCM services. Additional California-specific requirements include: California Consumer Privacy Act compliance required; Enhanced patient consent requirements. California has comprehensive telehealth parity laws. RPM is reimbursed at in-person rates for most payers.
This page provides general informational guidance only and does not constitute legal, compliance, or billing advice. Telehealth regulations, Medicaid coverage, and state privacy laws change frequently. Verify current requirements with your state health department, payers, and qualified healthcare compliance counsel before making program decisions. Demographic data is based on U.S. Census Bureau estimates. Data last verified: March 2026.
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.