What’s new with the CPT codebook when it comes to care coordination programs (like Chronic Care Management) from Medicare?  How about Principal Care Management:  a set of new codes, now expanded as of 2022.

“Principal Care Management” services are comparable to Chronic Care Management yet different in that this new program moves away from the two chronic condition requirements. Instead, PCM focuses on a single condition.  As opposed to primary care practices being the target for CCM, Specialty practices are primarily the focus for PCM. There is additional consideration for PCM being used in conjunction with other care coordination efforts at Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) care management program, with corresponding HCPCS code G0511.

New CPT Codes 99426, 99427

There are two new codes in the care management section of the CPT codebook, covering principal care management 99426 and 99427. For example, CPT code 99424 covers the first half hour of Principal Care Management service per calendar per month delivered by a physician or qualified healthcare professional. Each instance of 99427 covers the additional 30-minute intervals of care coordination in the PCM program per patient, per calendar month.

Specialists in clinics can now grow reimbursements from Medicare with the PCM program.  In addition to the first half hour of covered services clinics can cover more 30-minute increments of care coordination service with CPT 99427.  Both CPT Codes 99426, as well as 99427 for additional 30-minutes, are reimbursable when clinical staff meet the 30-minute code criteria by their care coordination efforts as directed by the physician or qualified healthcare professional. These efforts help alleviate provider burden as part of CMS quadruple aim and meeting the team-based care approach as covered by the rules.

One Care Coordination Service Line of Many

The CrossTx cloud-based care coordination and closed-loop referral management platform includes Medicare Fee For Value modules including Chronic Care Management, Behavioral Health integration, Remote Physiological Monitoring and more. Access the new and expanded CrossTx Principal Care Management module, a seamless cloud-based service that supports patient care, clinic Medicare reimbursement and compliance with Health and Human Services Centers for Medicare and Medicaid Services.

Check out CrossTx. www.crosstx.com