Principal Care Management in Virginia.
Focused management of a single high-complexity chronic condition. Medicare billing, VA Medicaid coverage, and compliance details for Virginia providers.
How does PCM work for providers in Virginia?
Principal Care Management (PCM) allows Virginia 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. VA Medicaid provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Virginia. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Sentara Healthcare and Inova Health System.
Medicare Billing
PCM billing in Virginia.
PCM uses federally standardized CPT codes with uniform reimbursement across Virginia. VA 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. VA 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
Virginia Medicaid Supplement
VA Medicaid provides partial supplementary coverage — check current VA Medicaid fee schedules for dual-eligible PCM rates. Virginia's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Virginia-Specific Billing Considerations
Virginia Consumer Data Protection Act compliance
Regulatory Landscape
PCM compliance in Virginia.
Beyond federal Medicare requirements, Virginia has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Virginia has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Virginia has comprehensive telehealth laws. Strong support for chronic care and remote monitoring programs.
Interstate Licensure
- *Virginia is a member of the Interstate Medical Licensure Compact, enabling physicians licensed through the compact to provide PCM services across state lines.
State Privacy Law
- *VCDPA applies to condition-specific treatment records managed under PCM programs.
- *Medication management records and care plan data must comply with both HIPAA and VCDPA.
Additional Requirements
- *Virginia Consumer Data Protection Act compliance
EHR Integrations
PCM-compatible EHRs.
Major Virginia health systems like Sentara Healthcare and Inova Health System 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 Virginia questions.
Virginia's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Sentara Healthcare and Inova Health System and remote clinics where in-person visits are difficult. VA Medicaid offers partial supplementary coverage for dual-eligible patients. Virginia's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, COPD among Virginia's patient population drives PCM enrollment.
VA Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. VA Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Virginia has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Virginia is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Virginia has comprehensive telehealth laws. Strong support for chronic care and remote monitoring programs.
Among Virginia's 1.4M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Virginia's urban practices often identify PCM candidates through existing chronic disease registries.
Virginia has approximately 1.4M residents aged 65+ (15.6% of the population), with +22% by 2035 projected growth. Northern Virginia has dense population near DC. Hampton Roads area has significant senior population. VCDPA creates additional privacy compliance requirements.
PCM in Virginia must comply with federal Medicare billing requirements and HIPAA. Virginia's VCDPA adds state-level data protection requirements for patient health information collected through PCM devices and platforms. As an Interstate Medical Licensure Compact member, Virginia allows compact-licensed physicians to deliver PCM services across state lines. Additional Virginia-specific requirements include: Virginia Consumer Data Protection Act compliance. Virginia has comprehensive telehealth laws. Strong support for chronic care and 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 Virginia.
Explore other Medicare remote care programs available to Virginia 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.