Principal Care Management in Utah.
Focused management of a single high-complexity chronic condition. Medicare billing, Utah Medicaid coverage, and compliance details for Utah providers.
How does PCM work for providers in Utah?
Principal Care Management (PCM) allows Utah 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. Utah Medicaid provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Utah. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Intermountain Health and University of Utah Health.
Medicare Billing
PCM billing in Utah.
PCM uses federally standardized CPT codes with uniform reimbursement across Utah. Utah 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. Utah 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
Utah Medicaid Supplement
Utah Medicaid provides partial supplementary coverage — check current Utah Medicaid fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in Utah.
Beyond federal Medicare requirements, Utah has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *Utah is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
EHR Integrations
PCM-compatible EHRs.
Major Utah health systems like Intermountain Health and University of Utah 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 Utah questions.
Utah's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Intermountain Health and University of Utah Health and remote clinics where in-person visits are difficult. Utah Medicaid offers partial supplementary coverage for dual-eligible patients. Utah's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, depression among Utah's patient population drives PCM enrollment.
Utah Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Utah Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among Utah's 0.4M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Utah's urban practices often identify PCM candidates through existing chronic disease registries.
Utah has approximately 0.4M residents aged 65+ (11.1% of the population), with +45% by 2035 projected growth. Youngest state by median age but fastest-growing senior population. Intermountain Health is a national leader in value-based care and telehealth. Strong technology infrastructure.
PCM in Utah must comply with federal Medicare billing requirements and HIPAA. Utah 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, Utah allows compact-licensed physicians to deliver PCM services across state lines. Utah has telehealth parity legislation. Strong technology adoption supports remote monitoring programs.
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 Utah.
Explore other Medicare remote care programs available to Utah 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.