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 partial supplementary coverage. Prevalent conditions like diabetes drive PCM demand across Texas. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including HCA Healthcare and Baylor Scott & White.
Medicare Billing
PCM billing in Texas.
PCM uses federally standardized CPT codes with uniform reimbursement across Texas. Texas 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. Texas 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
Texas Medicaid Supplement
Texas Medicaid provides partial supplementary coverage — check current Texas Medicaid fee schedules for dual-eligible PCM rates.
Texas-Specific Billing Considerations
Texas Medical Board telehealth guidelines compliance
Regulatory Landscape
PCM compliance in Texas.
Beyond federal Medicare requirements, Texas has specific telehealth, licensure, and privacy regulations that affect PCM programs.
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.
Major Texas health systems like HCA Healthcare and Baylor Scott & White 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 Texas questions.
Texas's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like HCA Healthcare and Baylor Scott & White and remote clinics where in-person visits are difficult. Texas Medicaid offers partial supplementary coverage for dual-eligible patients. Texas's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of diabetes, obesity, heart disease among Texas's patient population drives PCM enrollment.
Texas Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Texas Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among Texas's 3.9M seniors, patients with a single high-complexity condition — such as uncontrolled diabetes or advanced obesity — are prime PCM candidates. Texas's urban practices often identify PCM candidates through existing chronic disease registries.
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.
PCM in Texas must comply with federal Medicare billing requirements and HIPAA. Texas 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, Texas allows compact-licensed physicians to deliver PCM services across state lines. Additional Texas-specific requirements include: Texas Medical Board telehealth guidelines compliance. Texas expanded telehealth coverage significantly in 2021. STAR+PLUS managed care covers RPM for dual-eligible beneficiaries.
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 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.