Principal Care Management in Texas.
Focused management of a single high-complexity chronic condition. Medicare billing, Texas Medicaid coverage, and compliance details for Texas providers.
How does PCM work for providers in Texas?
Principal Care Management (PCM) allows Texas 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. Texas Medicaid provides full supplementary coverage. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing for Texas practices.
Medicare Billing
PCM billing in Texas.
PCM uses federally standardized CPT codes with uniform reimbursement across Texas. Texas 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. Texas 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 Texas.
Beyond federal Medicare requirements, Texas has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Texas has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Texas expanded telehealth coverage significantly in 2021. STAR+PLUS managed care covers RPM for dual-eligible beneficiaries.
Interstate Licensure
- *Texas is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
Additional Requirements
- *Texas Medical Board telehealth guidelines compliance
EHR Integrations
PCM-compatible EHRs.
CCN Health integrates with leading EHR platforms used by Texas 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 Texas questions.
PCM in Texas 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.
Texas Medicaid provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Texas Medicaid provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Texas has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Texas is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Texas expanded telehealth coverage significantly in 2021. STAR+PLUS managed care covers RPM for dual-eligible beneficiaries.
PCM in Texas 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.
Texas has approximately 3.9M residents aged 65+ (13% of the population), with +35% by 2035 projected growth. Rapidly growing senior population. Large rural areas benefit significantly from remote monitoring. STAR+PLUS program creates opportunities for dual-eligible SNF residents.
CCN Health helps Texas 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 Texas.
Explore other Medicare remote care programs available to Texas 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.