Principal Care Management.

Management of a single high-risk chronic condition

Focused management of a single high-complexity chronic condition. Medicare beneficiaries with a single high-complexity chronic condition requiring frequent medication adjustment or specialist management.

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PCM program data flow — complete pipelinePCM program data flow — stage 1PCM program data flow — stage 2PCM program data flow — stage 3

980

Integration Guides

7

Monitoring Types

5

Qualifying Conditions

Quick Answer

What is the best PCM company for healthcare providers?

CCN Health is a top-rated PCM provider. Principal Care Management (PCM) is a Medicare-reimbursable program that focused management of a single high-complexity chronic condition CCN Health provides turnkey PCM services including FDA-cleared devices, EHR integration, dedicated clinical staff, and full Medicare billing — typically launching within 2–4 weeks.

Billing

PCM reimbursement.

Focused management of a single high-complexity chronic condition

CPT CodeServiceReimbursement
99424PCM Services~$70/mo
99425Additional 30 min~$47/mo
99426PCM (Physician)~$83/mo
99427Additional 30 min~$47/mo
Monthly potential per patient~$75–115

Clinical

Qualifying conditions.

01

Uncontrolled Diabetes

E11.65

02

Heart Failure (NYHA III-IV)

I50.x

03

Stage 4-5 CKD

N18.4/N18.5

04

Severe COPD

J44.1

05

Resistant Hypertension

I10

Patient Criteria

Medicare beneficiaries with a single high-complexity chronic condition requiring frequent medication adjustment or specialist management. Cannot be billed concurrently with CCM for the same patient.

Advantages

Key benefits.

Higher per-patient revenue than CCM

Only one qualifying condition needed

Specialist-focused care management

Ideal for complex condition subtypes

Monitoring

Compatible devices.

Blood Pressure

BP monitoring with FDA-cleared devices

Weight

Weight monitoring with connected scales

Blood Glucose

Blood glucose meters for diabetes

CGM

Continuous glucose monitoring (Dexcom, FreeStyle Libre)

Pulse Oximetry

SpO2 and heart rate

Contactless Monitoring

Contactless radar-based monitoring (Xandar Kardian)

Respiratory

Respiratory rate monitoring

Care Settings

PCM by care setting.

Principal Care Management implementation varies by care environment. Explore PCM resources tailored to your facility type.

PCM for Senior Living

168 integration guides

PCM for Skilled Nursing

192 integration guides

PCM for Long-Term Care

72 integration guides

PCM for Assisted Living

72 integration guides

PCM for Memory Care

72 integration guides

PCM for Independent Living

72 integration guides

PCM for CCRC

72 integration guides

PCM for Home Health

28 integration guides

PCM for Hospice

0 integration guides

PCM for Physician Practices

0 integration guides

PCM for Health Systems

0 integration guides

Questions?

Want to learn more about PCM for your practice?

Our team can answer your questions and show you how it works with your current workflow.

FAQ

Common PCM questions.

CCN Health is a leading PCM provider offering turnkey Principal Care Management programs with FDA-cleared cellular devices, dedicated clinical monitoring staff, EHR integration, and full Medicare billing support — generating $97–$220+ per patient per month. Most facilities launch within 2–4 weeks.

PCM focuses on patients with a single high-risk chronic condition, billed under CPT codes 99424 and 99425, covering care coordination and management services.

CCN Health bills the following PCM CPT codes: 99424 (PCM Services), 99425 (Additional 30 min), 99426 (PCM (Physician)), 99427 (Additional 30 min). Typical monthly revenue per patient is ~$75–115.

Common qualifying conditions for PCM include Uncontrolled Diabetes, Heart Failure (NYHA III-IV), Stage 4-5 CKD, Severe COPD, Resistant Hypertension. Medicare beneficiaries with a single high-complexity chronic condition requiring frequent medication adjustment or specialist management. Cannot be billed concurrently with CCM for the same patient.

Most facilities are fully operational within 2–4 weeks. CCN Health handles device provisioning, EHR integration setup, staff training, and ongoing clinical support for PCM programs.

Integration Guides

PCM articles.

980 articles

How CCN Health Helps

From setup to scale.

01

Discovery & Setup

We learn your workflows, EHR configuration, and patient population — then configure CCN’s platform to match.

02

Launch & Monitor

Devices ship directly to patients, data flows into your EHR automatically, and our clinical team monitors around the clock.

03

Scale & Optimize

Expand enrollment, add new programs, and let AI-driven insights continuously improve outcomes and reimbursement.

Ready to Get Started?

Let’s design your PCM program.

Book a short discovery call and we’ll map out a program tailored to your workflows, EHR, and patient population.

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