Principal Care Management in South Carolina.
Focused management of a single high-complexity chronic condition. Medicare billing, Healthy Connections coverage, and compliance details for South Carolina providers.
How does PCM work for providers in South Carolina?
Principal Care Management (PCM) allows South 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. Healthy Connections provides partial supplementary coverage. Prevalent conditions like diabetes drive PCM demand across South Carolina. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Prisma Health and MUSC Health.
Medicare Billing
PCM billing in South Carolina.
PCM uses federally standardized CPT codes with uniform reimbursement across South Carolina. Healthy Connections 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. Healthy Connections 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
South Carolina Medicaid Supplement
Healthy Connections provides partial supplementary coverage — check current Healthy Connections fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in South Carolina.
Beyond federal Medicare requirements, South Carolina has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *South Carolina is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid South Carolina medical license.
EHR Integrations
PCM-compatible EHRs.
Major South Carolina health systems like Prisma Health and MUSC 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 South Carolina questions.
South Carolina's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Prisma Health and MUSC Health and remote clinics where in-person visits are difficult. Healthy Connections offers partial supplementary coverage for dual-eligible patients. High prevalence of diabetes, hypertension, heart disease among South Carolina's patient population drives PCM enrollment.
Healthy Connections provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Healthy Connections provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among South Carolina's 0.9M seniors, patients with a single high-complexity condition — such as uncontrolled diabetes or advanced hypertension — are prime PCM candidates. South Carolina's urban practices often identify PCM candidates through existing chronic disease registries.
South Carolina has approximately 0.9M residents aged 65+ (18.1% of the population), with +28% by 2035 projected growth. Fast-growing retiree population along the coast. Charleston and Greenville have strong healthcare markets. High demand for senior living monitoring in retirement communities.
PCM in South Carolina must comply with federal Medicare billing requirements and HIPAA. South Carolina does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. South Carolina is not part of the Interstate Medical Licensure Compact — providers must hold a valid South Carolina license to deliver PCM services. South Carolina has telehealth parity for most services. RPM coverage through Medicaid managed care varies by plan.
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 South Carolina.
Explore other Medicare remote care programs available to South 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.