Principal Care Management in Delaware.
Focused management of a single high-complexity chronic condition. Medicare billing, Delaware Medicaid coverage, and compliance details for Delaware providers.
How does PCM work for providers in Delaware?
Principal Care Management (PCM) allows Delaware 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. Delaware Medicaid provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Delaware. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 4+ major health systems including ChristianaCare and Bayhealth.
Medicare Billing
PCM billing in Delaware.
PCM uses federally standardized CPT codes with uniform reimbursement across Delaware. Delaware Medicaid provides partial 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. Delaware Medicaid provides partial 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
Delaware Medicaid Supplement
Delaware Medicaid provides partial supplementary coverage — check current Delaware Medicaid fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in Delaware.
Beyond federal Medicare requirements, Delaware has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *Delaware is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid Delaware medical license.
EHR Integrations
PCM-compatible EHRs.
Major Delaware health systems like ChristianaCare and Bayhealth use EHR platforms that CCN Health integrates with. 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 Delaware questions.
Delaware's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like ChristianaCare and Bayhealth and remote clinics where in-person visits are difficult. Delaware Medicaid offers partial supplementary coverage for dual-eligible patients. High prevalence of heart disease, diabetes, hypertension among Delaware's patient population drives PCM enrollment.
Delaware Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Delaware Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among Delaware's 0.2M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Delaware's urban practices often identify PCM candidates through existing chronic disease registries.
Delaware has approximately 0.2M residents aged 65+ (19% of the population), with +18% by 2035 projected growth. Small state with high senior population concentration. ChristianaCare dominates the market. Beach communities in southern Delaware have growing retirement populations.
PCM in Delaware must comply with federal Medicare billing requirements and HIPAA. Delaware does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. Delaware is not part of the Interstate Medical Licensure Compact — providers must hold a valid Delaware license to deliver PCM services. Delaware has telehealth parity. Medicaid covers remote monitoring through managed care organizations.
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 Delaware.
Explore other Medicare remote care programs available to Delaware 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.