Principal Care Management in Massachusetts.
Focused management of a single high-complexity chronic condition. Medicare billing, MassHealth coverage, and compliance details for Massachusetts providers.
How does PCM work for providers in Massachusetts?
Principal Care Management (PCM) allows Massachusetts 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. MassHealth provides full supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Massachusetts. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Mass General Brigham and Beth Israel Lahey Health. Massachusetts's dense urban healthcare market supports strong adoption of remote care programs.
Medicare Billing
PCM billing in Massachusetts.
PCM uses federally standardized CPT codes with uniform reimbursement across Massachusetts. MassHealth 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. MassHealth 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
Massachusetts Medicaid Supplement
MassHealth provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. Massachusetts's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Regulatory Landscape
PCM compliance in Massachusetts.
Beyond federal Medicare requirements, Massachusetts has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Massachusetts has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Massachusetts has strong telehealth parity. MassHealth was among the first to cover remote monitoring comprehensively.
Interstate Licensure
- *Massachusetts is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid Massachusetts medical license.
EHR Integrations
PCM-compatible EHRs.
Major Massachusetts health systems like Mass General Brigham and Beth Israel Lahey 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 Massachusetts questions.
Massachusetts's dense healthcare market and 5+ major health systems like Mass General Brigham and Beth Israel Lahey Health create strong infrastructure for PCM adoption. MassHealth provides full supplementary coverage, maximizing dual-eligible revenue. High prevalence of heart disease, diabetes, COPD among Massachusetts's patient population drives PCM enrollment.
MassHealth provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. MassHealth provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Massachusetts has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Massachusetts has strong telehealth parity. MassHealth was among the first to cover remote monitoring comprehensively.
Among Massachusetts's 1.1M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Massachusetts's urban practices often identify PCM candidates through existing chronic disease registries.
Massachusetts has approximately 1.1M residents aged 65+ (16.5% of the population), with +12% by 2035 projected growth. World-class academic medical centers drive innovation. Dense senior living market in greater Boston. Strong value-based care adoption creates demand for remote monitoring.
PCM in Massachusetts must comply with federal Medicare billing requirements and HIPAA. Massachusetts does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. Massachusetts is not part of the Interstate Medical Licensure Compact — providers must hold a valid Massachusetts license to deliver PCM services. Massachusetts has strong telehealth parity. MassHealth was among the first to cover remote monitoring comprehensively.
Massachusetts Regulatory Sources
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 Massachusetts.
Explore other Medicare remote care programs available to Massachusetts 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.