Principal Care Management in West Virginia.
Focused management of a single high-complexity chronic condition. Medicare billing, WV Medicaid coverage, and compliance details for West Virginia providers.
How does PCM work for providers in West Virginia?
Principal Care Management (PCM) allows West 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. WV Medicaid provides partial supplementary coverage. Prevalent conditions like heart disease drive PCM demand across West Virginia. CCN Health streamlines PCM workflows including condition-specific care plans, medication management tracking, and automated billing — integrating with 5+ major health systems including WVU Medicine and CAMC Health System. West Virginia's predominantly rural geography makes remote monitoring especially critical for healthcare access.
Medicare Billing
PCM billing in West Virginia.
PCM uses federally standardized CPT codes with uniform reimbursement across West Virginia. WV 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. WV 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
West Virginia Medicaid Supplement
WV Medicaid provides partial supplementary coverage — check current WV Medicaid fee schedules for dual-eligible PCM rates.
Regulatory Landscape
PCM compliance in West Virginia.
Beyond federal Medicare requirements, West Virginia has specific telehealth, licensure, and privacy regulations that affect PCM programs.
Interstate Licensure
- *West Virginia 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 West Virginia health systems like WVU Medicine and CAMC Health System 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 West Virginia questions.
As a predominantly rural state, West Virginia providers particularly benefit from PCM's remote care capabilities, reducing the need for patients to travel long distances. WV Medicaid offers partial supplementary coverage for dual-eligible patients. West Virginia's membership in the Interstate Medical Licensure Compact enables cross-state PCM delivery. High prevalence of heart disease, diabetes, COPD among West Virginia's patient population drives PCM enrollment.
WV Medicaid provides partial supplementary coverage for PCM services. Medicare covers PCM under the same framework as CCM. WV Medicaid provides partial supplementary coverage. For dual-eligible beneficiaries, providers can bill both Medicare and Medicaid to maximize reimbursement.
Among West Virginia's 0.4M seniors, patients with a single high-complexity condition — such as uncontrolled heart disease or advanced diabetes — are prime PCM candidates. In West Virginia's rural areas, PCM enables focused management without frequent office visits. West Virginia's lower Medicare Advantage penetration means most seniors are on original Medicare, which fully covers PCM under fee-for-service billing.
West Virginia has approximately 0.4M residents aged 65+ (21.3% of the population), with +8% by 2035 projected growth. Highest median age in the US. Extreme chronic disease burden and rural geography make remote monitoring critical. Appalachian communities face significant healthcare access challenges.
PCM in West Virginia must comply with federal Medicare billing requirements and HIPAA. West Virginia 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, West Virginia allows compact-licensed physicians to deliver PCM services across state lines. West Virginia has telehealth parity. Expanded Medicaid provides comprehensive RPM and CCM coverage.
West Virginia Regulatory Sources
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 West Virginia.
Explore other Medicare remote care programs available to West 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.