Disease-Specific Care Plan
A care plan built around the one condition being treated: problems, goals, expected outcomes, interventions and periodic review.
Focused Care Management For One High-Risk Condition
e-Vitals gives specialists a structured way to manage a single complex condition between visits, with a disease-specific care plan and time tracking built in.
What Is Principal Care Management?
Principal Care Management covers care management for patients with one complex chronic condition expected to last at least three months.
It gives specialists a way to deliver and document focused, between-visit management of the condition they are treating.
Who Qualifies For PCM
- One complex chronic condition expected to last at least 3 months.
- The condition places the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death.
- The condition requires development, monitoring or revision of a disease-specific care plan.
- Frequent adjustments to the medication regimen, or management made unusually complex by comorbidities.
- Ongoing communication and care coordination between the practitioners treating the patient.
- Documented patient consent, verbal or written, captured before billing.
Example Principal Conditions
Not an exhaustive list. PCM focuses on the one complex condition the billing practitioner is managing.
Heart failureResistant hypertensionUncontrolled diabetesChronic kidney diseaseCOPDSevere asthmaAtrial fibrillationCancerRheumatoid arthritisMultiple sclerosisParkinson's diseaseInflammatory bowel disease
What PCM Includes
PCM is built around one condition and a care plan written for it. e-Vitals operationalizes each element.
Medication Management
Track medication changes and adherence, so titration happens between visits rather than at the next appointment.
Ongoing Monitoring
Review symptoms and, when paired with RPM, the home readings that show how the condition is responding.
Care Coordination
Keep primary care and other treating clinicians informed, with a plan that stays separate from any CCM.
Patient Communication
Scheduled check-ins and secure messaging give the patient a direct line to the care team for the condition.
Time Tracking & Documentation
Physician and clinical staff minutes are logged separately in 30-minute units, with audit-ready records.
How PCM Works Each Month
- 01
Initiating Visit
Required only for new patients or those not seen in the past year, completed during a comprehensive E/M visit, Annual Wellness Visit or IPPE.
- 02
Patient Consent
Obtain and document verbal or written consent, including that cost sharing may apply and that the patient can stop at any time.
- 03
Build The Care Plan
Write a disease-specific care plan for the principal condition and share it with the patient and the care team.
- 04
Manage & Log Time
Monitor the condition, adjust treatment and log the time: at least 30 minutes of physician or clinical staff time for the month.
- 05
Document & Bill
Submit 99424 or 99426 for the first 30 minutes, with add-on codes for each additional 30, backed by audit-ready documentation.
How e-Vitals Simplifies PCM
- 01
A Disease-Specific Care Plan
Build the plan around the one condition you are treating, with targets and next steps visible to the whole team.
- 02
Home Readings In Context
Pair PCM with connected devices so medication changes show their effect within days, not at the next appointment.
- 03
Time Tracked In 30-Minute Units
Physician and clinical staff time are logged separately, matching how the PCM codes are structured.
- 04
Clean Hand-Offs With Primary Care
Separate care plans keep PCM distinct from any CCM a primary care practice is billing for other conditions.
How Much Do PCM CPT Codes Reimburse?
| CPT Code | What it covers | Time / requirement | Est. reimbursement* |
|---|---|---|---|
| 99424 | PCM by physician, first 30 minutes | 30 minutes personally spent on one complex condition | ~$83.50 / month |
| 99425 | PCM by physician, each additional 30 | Each additional 30 minutes of physician or QHP time | ~$60.20 / unit |
| 99426 | PCM by clinical staff, first 30 minutes | 30 minutes directed by the billing practitioner | ~$62.80 / month |
| 99427 | PCM by clinical staff, each additional 30 | Each additional 30 minutes of clinical staff time | ~$48.50 / unit |
Physician Vs. Staff Time
99424 and 99425 count time personally spent by the physician or QHP; 99426 and 99427 count clinical staff time directed by the practitioner. Each starts at 30 minutes in the calendar month.
Who Can Bill
Physicians and non-physician practitioners eligible to bill E/M services, most often the specialist managing the condition, such as a cardiologist or nephrologist.
Supervision
Clinical staff codes are furnished under general supervision. The billing practitioner directs the care but needn't be physically present.
*Reimbursement figures are approximate 2026 Medicare national-average non-facility rates for educational purposes only and are not billing, legal, or financial advice. Rates change annually and vary by payer and locality. Verify against the current Medicare Physician Fee Schedule before billing. CPT® is a registered trademark of the American Medical Association.
Billing It Right: What Runs Together, What Doesn't
PCM can be combined with several services, and is mutually exclusive with others. e-Vitals tracks time per program so distinct minutes stay distinct.
Can Run Alongside PCM
- Remote patient monitoring (RPM): can be billed in the same month as PCM when the time counted toward each is distinct.
- Chronic care management (CCM): allowed when a different practitioner manages the patient's other conditions under a separate care plan.
- The initiating visit: a comprehensive E/M visit, AWV or IPPE is separately billable and isn't part of PCM time.
Can't Be Billed Together
- CCM and PCM by the same practitioner for the same patient in the same month.
- Physician PCM (99424 / 99425) and clinical staff PCM (99426 / 99427) for the same patient in the same month.
- Any time already counted toward another billed code. PCM minutes can never be counted twice.
PCM Fits The Patients You Already Manage
The signals that matter most differ by specialty.
Cardiology
Manage heart failure or resistant hypertension as the principal condition.
Endocrinology
Structured management for patients with uncontrolled diabetes.
Nephrology
Focused management of chronic kidney disease between visits.
Primary Care
For patients whose risk is driven by one condition rather than several.
PCM Questions, Answered
What is Principal Care Management (PCM)?
PCM is a Medicare-paid service for managing one complex chronic condition expected to last at least 3 months. It covers the between-visit work of a disease-specific care plan: monitoring the condition, adjusting treatment and coordinating with other clinicians. It is billed per calendar month under the Physician Fee Schedule.
Which patients are eligible for PCM?
Patients with a single high-risk condition that places them at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death, and that needs a disease-specific care plan. Heart failure, uncontrolled diabetes and chronic kidney disease are typical examples.
How is PCM different from CCM?
CCM is for patients with two or more chronic conditions. PCM is for patients with one complex, high-risk condition and is often delivered by the specialist managing it.
Who can bill for PCM?
Physicians and non-physician practitioners eligible to bill evaluation and management services, such as nurse practitioners and physician assistants. It is most often billed by the specialist managing the condition.
Is patient consent required, and can it be verbal?
Yes. Consent is required before billing, and it may be verbal or written. Inform the patient that cost sharing may apply and that they can stop at any time, then document it.
What's the difference between the physician and staff PCM codes?
99424 (first 30 minutes) and 99425 (each additional 30) count time personally spent by the physician or QHP. 99426 and 99427 count clinical staff time directed by the billing practitioner. Bill one set or the other for a patient in a given month.
Can PCM be billed with RPM?
Yes. RPM can be billed in the same month as PCM as long as time is not counted toward more than one service.
Can a specialist bill PCM while primary care bills CCM?
Yes, when the two practitioners address different conditions under separate care plans.
What documentation is required?
A disease-specific care plan, documented consent and a record of the time spent each month, attributed to either the physician or QHP or to clinical staff.
Build A Modern, Scalable PCM Program
See how e-Vitals helps your practice launch, run and document Medicare care programs with devices, onboarding, clinical dashboards and billing support in one platform.