Principal Care Management in Minnesota.
Focused management of a single high-complexity chronic condition. Medicare billing, Medical Assistance coverage, and compliance details for Minnesota providers.
How does PCM work for providers in Minnesota?
Principal Care Management (PCM) allows Minnesota 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. Medical Assistance provides full supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Minnesota. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 6+ major health systems including Mayo Clinic and Allina Health.
Medicare Billing
PCM billing in Minnesota.
PCM uses federally standardized CPT codes with uniform reimbursement across Minnesota. Medical Assistance 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. Medical Assistance 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
Minnesota Medicaid Supplement
Medical Assistance provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. Minnesota's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Minnesota-Specific Billing Considerations
Minnesota Health Records Act provides additional patient privacy protections
Regulatory Landscape
PCM compliance in Minnesota.
Beyond federal Medicare requirements, Minnesota has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Minnesota has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Minnesota was an early telehealth adopter. Medical Assistance and MinnesotaCare provide comprehensive remote monitoring coverage.
Interstate Licensure
- *Minnesota is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
State Privacy Law
- *MN Health Records Act applies to condition-specific treatment records managed under PCM programs.
- *Medication management records and care plan data must comply with both HIPAA and MN Health Records Act.
Additional Requirements
- *Minnesota Health Records Act provides additional patient privacy protections
EHR Integrations
PCM-compatible EHRs.
Major Minnesota health systems like Mayo Clinic and Allina Health 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 Minnesota questions.
Minnesota's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Mayo Clinic and Allina Health and remote clinics where in-person visits are difficult. Medical Assistance provides full supplementary coverage, maximizing dual-eligible revenue. Minnesota's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, COPD among Minnesota's patient population drives PCM enrollment.
Medical Assistance provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Medical Assistance provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Minnesota has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Minnesota is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Minnesota was an early telehealth adopter. Medical Assistance and MinnesotaCare provide comprehensive remote monitoring coverage.
Among Minnesota's 0.9M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Minnesota's urban practices often identify PCM candidates through existing chronic disease registries. Minnesota's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
Minnesota has approximately 0.9M residents aged 65+ (15.8% of the population), with +22% by 2035 projected growth. Mayo Clinic and strong health systems drive innovation. Extensive rural areas benefit from remote monitoring. Leading state in value-based care and population health management.
PCM in Minnesota must comply with federal Medicare billing requirements and HIPAA. Minnesota's MN Health Records Act adds state-level data protection requirements for patient health information collected through PCM devices and platforms. As an Interstate Medical Licensure Compact member, Minnesota allows compact-licensed physicians to deliver PCM services across state lines. Additional Minnesota-specific requirements include: Minnesota Health Records Act provides additional patient privacy protections. Minnesota was an early telehealth adopter. Medical Assistance and MinnesotaCare provide comprehensive remote monitoring coverage.
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 Minnesota.
Explore other Medicare remote care programs available to Minnesota 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.