Principal Care Management in New York.
Focused management of a single high-complexity chronic condition. Medicare billing, NY Medicaid coverage, and compliance details for New York providers.
How does PCM work for providers in New York?
Principal Care Management (PCM) allows New York 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. NY Medicaid provides full supplementary coverage. Prevalent conditions like heart disease drive PCM demand across New York. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including NewYork-Presbyterian and Northwell Health. New York's dense urban healthcare market supports strong adoption of remote care programs.
Medicare Billing
PCM billing in New York.
PCM uses federally standardized CPT codes with uniform reimbursement across New York. NY Medicaid 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. NY Medicaid 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
New York Medicaid Supplement
NY Medicaid provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. New York's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
New York-Specific Billing Considerations
SHIELD Act data security requirements
Enhanced breach notification requirements
Regulatory Landscape
PCM compliance in New York.
Beyond federal Medicare requirements, New York has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *New York has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *New York has strong telehealth parity laws established during COVID-19 and made permanent. Active in value-based care initiatives.
Interstate Licensure
- *New York is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid New York medical license.
State Privacy Law
- *NY SHIELD Act applies to condition-specific treatment records managed under PCM programs.
- *Medication management records and care plan data must comply with both HIPAA and NY SHIELD Act.
Additional Requirements
- *SHIELD Act data security requirements
- *Enhanced breach notification requirements
EHR Integrations
PCM-compatible EHRs.
Major New York health systems like NewYork-Presbyterian and Northwell 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 New York questions.
New York's dense healthcare market and 5+ major health systems like NewYork-Presbyterian and Northwell Health create strong infrastructure for PCM adoption. NY Medicaid provides full supplementary coverage, maximizing dual-eligible revenue. High prevalence of heart disease, diabetes, COPD among New York's patient population drives PCM enrollment.
NY Medicaid provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. NY Medicaid provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
New York has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. New York has strong telehealth parity laws established during COVID-19 and made permanent. Active in value-based care initiatives.
Among New York's 3.4M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. New York's urban practices often identify PCM candidates through existing chronic disease registries. New York's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
New York has approximately 3.4M residents aged 65+ (17.5% of the population), with +15% by 2035 projected growth. Dense urban population with sophisticated healthcare infrastructure. Strong adoption of RPM in skilled nursing and home health. Value-based care models drive preventive monitoring.
PCM in New York must comply with federal Medicare billing requirements and HIPAA. New York's NY SHIELD Act adds state-level data protection requirements for patient health information collected through PCM devices and platforms. New York is not part of the Interstate Medical Licensure Compact — providers must hold a valid New York license to deliver PCM services. Additional New York-specific requirements include: SHIELD Act data security requirements; Enhanced breach notification requirements. New York has strong telehealth parity laws established during COVID-19 and made permanent. Active in value-based care initiatives.
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 New York.
Explore other Medicare remote care programs available to New York 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.