Principal Care Management in Washington.
Focused management of a single high-complexity chronic condition. Medicare billing, Apple Health coverage, and compliance details for Washington providers.
How does PCM work for providers in Washington?
Principal Care Management (PCM) allows Washington 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. Apple Health provides full supplementary coverage. Prevalent conditions like heart disease drive PCM demand across Washington. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including Providence and MultiCare Health System.
Medicare Billing
PCM billing in Washington.
PCM uses federally standardized CPT codes with uniform reimbursement across Washington. Apple Health 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. Apple Health 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
Washington Medicaid Supplement
Apple Health provides full supplementary coverage for dual-eligible PCM patients. Providers can bill both Medicare and Medicaid to maximize reimbursement for PCM services. Washington's telehealth parity law supports remote PCM delivery at equivalent reimbursement rates.
Washington-Specific Billing Considerations
Washington My Health My Data Act compliance required
Enhanced consent requirements for health data
Regulatory Landscape
PCM compliance in Washington.
Beyond federal Medicare requirements, Washington has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Telehealth Parity
- *Washington has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits.
- *Washington was one of the first states with telehealth parity. Apple Health provides comprehensive coverage for remote monitoring.
Interstate Licensure
- *Washington 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
- *My Health My Data Act applies to condition-specific treatment records managed under PCM programs.
- *Medication management records and care plan data must comply with both HIPAA and My Health My Data Act.
Additional Requirements
- *Washington My Health My Data Act compliance required
- *Enhanced consent requirements for health data
EHR Integrations
PCM-compatible EHRs.
Major Washington health systems like Providence and MultiCare 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 Washington questions.
Washington's mix of urban centers and rural communities means PCM serves both high-volume practices affiliated with systems like Providence and MultiCare Health System and remote clinics where in-person visits are difficult. Apple Health provides full supplementary coverage, maximizing dual-eligible revenue. Washington's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, depression among Washington's patient population drives PCM enrollment.
Apple Health provides full supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. Apple Health provides full supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Washington has telehealth parity legislation requiring PCM services to be reimbursed at equivalent rates compared to in-person visits. Washington is a member of the Interstate Medical Licensure Compact, facilitating cross-state PCM delivery. Washington was one of the first states with telehealth parity. Apple Health provides comprehensive coverage for remote monitoring.
Among Washington's 1.3M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. Washington's urban practices often identify PCM candidates through existing chronic disease registries.
Washington has approximately 1.3M residents aged 65+ (16% of the population), with +25% by 2035 projected growth. Seattle metro area is tech-savvy with high telehealth adoption. Eastern Washington has rural telehealth needs. My Health My Data Act creates strict privacy requirements.
PCM in Washington must comply with federal Medicare billing requirements and HIPAA. Washington's My Health My Data Act adds state-level data protection requirements for patient health information collected through PCM devices and platforms. As an Interstate Medical Licensure Compact member, Washington allows compact-licensed physicians to deliver PCM services across state lines. Additional Washington-specific requirements include: Washington My Health My Data Act compliance required; Enhanced consent requirements for health data. Washington was one of the first states with telehealth parity. Apple Health provides comprehensive coverage for 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 Washington.
Explore other Medicare remote care programs available to Washington 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.