Principal Care Management in Oregon.
Focused management of a single high-complexity chronic condition. Medicare billing, Oregon Health Plan coverage, and compliance details for Oregon providers.
How does PCM work for providers in Oregon?
Principal Care Management (PCM) allows Oregon 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. Oregon Health Plan provides full supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Oregon. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Providence Health & Services and OHSU Health.
Medicare Billing
PCM billing in Oregon.
PCM uses federally standardized CPT codes with uniform reimbursement across Oregon. Oregon Health Plan 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. Oregon Health Plan 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
Oregon Medicaid Supplement
Oregon Health Plan provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. Oregon's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Regulatory Landscape
PCM compliance in Oregon.
Beyond federal Medicare requirements, Oregon has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Oregon has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Oregon has strong telehealth parity through the Oregon Health Plan. Coordinated Care Organizations (CCOs) support remote monitoring programs.
Interstate Licensure
- *Oregon 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 Oregon health systems like Providence Health & Services and OHSU 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 Oregon questions.
Oregon's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Providence Health & Services and OHSU Health and remote clinics where in-person visits are difficult. Oregon Health Plan provides full supplementary coverage, maximizing dual-eligible revenue. Oregon's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, depression among Oregon's patient population drives PCM enrollment.
Oregon Health Plan provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Oregon Health Plan provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Oregon has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Oregon is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Oregon has strong telehealth parity through the Oregon Health Plan. Coordinated Care Organizations (CCOs) support remote monitoring programs.
Among Oregon's 0.8M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Oregon's urban practices often identify PCM candidates through existing chronic disease registries. Oregon's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
Oregon has approximately 0.8M residents aged 65+ (18.3% of the population), with +25% by 2035 projected growth. Portland metro area has strong healthcare infrastructure. Rural eastern Oregon has significant telehealth needs. CCO model aligns well with value-based remote monitoring programs.
PCM in Oregon must comply with federal Medicare billing requirements and HIPAA. Oregon 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, Oregon allows compact-licensed physicians to deliver PCM services across state lines. Oregon has strong telehealth parity through the Oregon Health Plan. Coordinated Care Organizations (CCOs) support remote monitoring programs.
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 Oregon.
Explore other Medicare remote care programs available to Oregon 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.