Principal Care Management in Vermont.
Focused management of a single high-complexity chronic condition. Medicare billing, Green Mountain Care coverage, and compliance details for Vermont providers.
How does PCM work for providers in Vermont?
Principal Care Management (PCM) allows Vermont 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. Green Mountain Care provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Vermont. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 4+ major health systems including University of Vermont Health Network and Dartmouth Health (Vermont). Vermont's predominantly rural geography makes remote monitoring especially critical for healthcare access.
Medicare Billing
PCM billing in Vermont.
PCM uses federally standardized CPT codes with uniform reimbursement across Vermont. Green Mountain Care 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. Green Mountain Care 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
Vermont Medicaid Supplement
Green Mountain Care provides partial supplementary coverage — check current Green Mountain Care fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in Vermont.
Beyond federal Medicare requirements, Vermont has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *Vermont is not currently a member of the Interstate Medical Licensure Compact. Providers delivering PCM services must hold a valid Vermont medical license.
EHR Integrations
PCM-compatible EHRs.
Major Vermont health systems like University of Vermont Health Network and Dartmouth Health (Vermont) 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 Vermont questions.
As a predominantly rural state, Vermont providers particularly benefit from PCM's remote care capabilities, reducing the need for patients to travel long distances. Green Mountain Care offers partial supplementary coverage for dual-eligible patients. High prevalence of heart disease, COPD, diabetes among Vermont's patient population drives PCM enrollment.
Green Mountain Care provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Green Mountain Care provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among Vermont's 0.1M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced COPD — are prime PCM candidates. In Vermont's rural areas, PCM enables focused management without frequent office visits.
Vermont has approximately 0.1M residents aged 65+ (18.7% of the population), with +10% by 2035 projected growth. High senior population percentage with rural geography. UVM Health Network covers most of the state. All-payer ACO model supports value-based remote monitoring.
PCM in Vermont must comply with federal Medicare billing requirements and HIPAA. Vermont does not currently have a comprehensive state privacy law beyond HIPAA, but standard patient consent and data security requirements apply. Vermont is not part of the Interstate Medical Licensure Compact — providers must hold a valid Vermont license to deliver PCM services. Vermont has strong telehealth parity. Green Mountain Care provides comprehensive coverage including remote monitoring.
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 Vermont.
Explore other Medicare remote care programs available to Vermont 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.