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 full supplementary coverage. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing for Pennsylvania practices.
Medicare Billing
PCM billing in Pennsylvania.
PCM uses federally standardized CPT codes with uniform reimbursement across Pennsylvania. PA 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. PA 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
Regulatory Landscape
PCM compliance in Pennsylvania.
Beyond federal Medicare requirements, Pennsylvania has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Pennsylvania has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
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.
CCN Health integrates with leading EHR platforms used by Pennsylvania providers. 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 Pennsylvania questions.
PCM in Pennsylvania uses Medicare CPT codes 99424, 99425, 99426, 99427. These are federal codes with uniform reimbursement nationwide, generating ~$75-$115/mo per patient per enrolled patient per month.
PA Medicaid provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. PA Medicaid provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Pennsylvania has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Pennsylvania is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Pennsylvania joined the Interstate Medical Licensure Compact. Telehealth parity established for most services.
PCM in Pennsylvania focuses on a single high-complexity chronic condition requiring frequent medication or treatment adjustments (e.g., uncontrolled diabetes or complex heart failure). Unlike CCM, PCM does not require two or more conditions. PCM and CCM cannot be billed for the same patient in the same month.
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.
CCN Health helps Pennsylvania providers launch PCM in three steps: (1) Discovery — we assess your EHR, workflows, and patient population; (2) Launch — devices ship to patients, data flows into your EHR automatically; (3) Scale — expand enrollment and add programs as your PCM census grows. Most practices begin billing within 2-4 weeks.
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.