Principal Care Management in Pennsylvania.
Focused management of a single high-complexity chronic condition. Medicare billing, PA Medicaid coverage, and compliance details for Pennsylvania providers.
How does PCM work for providers in Pennsylvania?
Principal Care Management (PCM) allows Pennsylvania 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. PA Medicaid provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Pennsylvania. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including UPMC and Penn Medicine.
Medicare Billing
PCM billing in Pennsylvania.
PCM uses federally standardized CPT codes with uniform reimbursement across Pennsylvania. PA 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. PA 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
Pennsylvania Medicaid Supplement
PA Medicaid provides partial supplementary coverage — check current PA Medicaid fee schedules for dual-eligible PCM rates.
Pennsylvania-Specific Billing Considerations
Pennsylvania telehealth registration requirements
Regulatory Landscape
PCM compliance in Pennsylvania.
Beyond federal Medicare requirements, Pennsylvania has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *Pennsylvania is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
Additional Requirements
- *Pennsylvania telehealth registration requirements
EHR Integrations
PCM-compatible EHRs.
Major Pennsylvania health systems like UPMC and Penn Medicine 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 Pennsylvania questions.
Pennsylvania's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like UPMC and Penn Medicine and remote clinics where in-person visits are difficult. PA Medicaid offers partial supplementary coverage for dual-eligible patients. Pennsylvania's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, COPD among Pennsylvania's patient population drives PCM enrollment.
PA Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. PA Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among Pennsylvania's 2.5M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Pennsylvania's urban practices often identify PCM candidates through existing chronic disease registries. Pennsylvania's high Medicare Advantage penetration means many seniors are already enrolled in plans that support PCM.
Pennsylvania has approximately 2.5M residents aged 65+ (19.4% of the population), with +12% by 2035 projected growth. Mature healthcare market with strong academic medical centers. Significant rural population benefits from telehealth. UPMC and Geisinger are leaders in value-based care.
PCM in Pennsylvania must comply with federal Medicare billing requirements and HIPAA. Pennsylvania 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, Pennsylvania allows compact-licensed physicians to deliver PCM services across state lines. Additional Pennsylvania-specific requirements include: Pennsylvania telehealth registration requirements. Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
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 Pennsylvania.
Explore other Medicare remote care programs available to Pennsylvania 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.