Principal Care Management in North Carolina.
Focused management of a single high-complexity chronic condition. Medicare billing, NC Medicaid coverage, and compliance details for North Carolina providers.
How does PCM work for providers in North Carolina?
Principal Care Management (PCM) allows North Carolina 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. NC Medicaid provides partial supplementary coverage. Prevalent conditions like diabetes drive PCM demand across North Carolina. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Atrium Health and Duke Health.
Medicare Billing
PCM billing in North Carolina.
PCM uses federally standardized CPT codes with uniform reimbursement across North Carolina. NC 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. NC 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
North Carolina Medicaid Supplement
NC Medicaid provides partial supplementary coverage — check current NC Medicaid fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in North Carolina.
Beyond federal Medicare requirements, North Carolina has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *North Carolina is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
EHR Integrations
PCM-compatible EHRs.
Major North Carolina health systems like Atrium Health and Duke 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 North Carolina questions.
North Carolina's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Atrium Health and Duke Health and remote clinics where in-person visits are difficult. NC Medicaid offers partial supplementary coverage for dual-eligible patients. North Carolina's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of diabetes, heart disease, COPD among North Carolina's patient population drives PCM enrollment.
NC Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. NC Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among North Carolina's 1.8M seniors, patients with a single high-complexity condition — such as uncontrolled diabetes or advanced heart disease — are prime PCM candidates. North Carolina's urban practices often identify PCM candidates through existing chronic disease registries.
North Carolina has approximately 1.8M residents aged 65+ (16.3% of the population), with +25% by 2035 projected growth. Fast-growing retiree population, especially in coastal and mountain communities. Strong academic medical center presence. Recent Medicaid expansion increases covered population.
PCM in North Carolina must comply with federal Medicare billing requirements and HIPAA. North Carolina does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. As an Interstate Medical Licensure Compact member, North Carolina allows compact-licensed physicians to deliver PCM services across state lines. North Carolina completed Medicaid expansion in 2023. Strong telehealth adoption in the Research Triangle and Charlotte areas.
North Carolina 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 North Carolina.
Explore other Medicare remote care programs available to North Carolina 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.