2022 Revised Codes for Principal Care Management
                     
2022 Revised Codes for Principal Care Management
In the Final Medicare Physician Fee Schedule (MPFS) for 2022 issued on November 2, 2021, the Centers for 
Medicare and Medicaid Services (CMS) added five new CPT codes in the categories of Chronic Care 
Management (CCM) and Principal Care Management (PCM) and increased reimbursement for already existing 
codes in the same categories. These codes are like chronic care management services in that the work involves 
the establishment, implementation, revision, and monitoring of a care plan for a patient. However, principal 
care management focuses on a single condition (rather than two or more). In the year 2022, Medicare will 
accept CPT codes 99424, 99425, 99426, and 99427, and discontinue HCPCS codes G2064 and G2065.
2022 Revised Codes for Principal Care Management
one complex chronic condition expected to last at least 3 months, and that places the patient at significant risk 
of hospitalization, acute exacerbation/ decompensation, functional decline, or death, the condition requires 
development, monitoring, or revision of a disease-specific care plan, the condition requires frequent 
adjustments in the medication regimen, and/or the management of the condition is unusually complex due to 
comorbidities, ongoing communication and care coordination between relevant practitioners furnishing care. 
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2022 Revised Codes for Principal Care Management
The first 30 minutes are provided personally by a physician or other qualified health care professional, per 
calendar month. The reimbursement rate for CPT 99424 in the year 2022 is $81. 
CPT 99425: For each additional 30 minutes provided personally by a physician or other qualified health care 
professional, per calendar month (List separately in addition to code for primary procedure. The 
reimbursement rate for CPT 99424 + 99425 in the year 2022 is $139.
CPT 99426: Principal care management services, for a single……. between relevant practitioners furnishing care. 
The first 30 minutes of clinical staff time are directed by the physician or other qualified health care 
professional, per calendar month. The reimbursement rate for CPT 99426 in the year 2022 is $61.
CPT 99427: For each additional 30 minutes of clinical staff time directed by a physician or other qualified health 
care professional per calendar month (List separately in addition to code for primary procedure. The 
reimbursement rate for CPT 99426 + 99427 in the year 2022 is $108.
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2022 Revised Codes for Principal Care Management
PCM Vs CCM
Principal care management (PCM) works much like chronic care management (CCM). Both programs help 
address chronic illness, but PCM is focused on treating only one, sole issue. To qualify for PCM, the patient must 
have a diagnosis that is expected to last between three months to a year or is life-long. The condition must be 
associated with recent hospitalization, and/or place the patient at significant risk of death, acute exacerbation 
or decompensation, or in a state of functional decline. For your patient to participate in PCM, they must 
provide written or verbal consent, which in turn must be documented by your practice. Another key difference 
between PCM and CCM is the time required for billing. While CCM has a 20-minute requirement, PCM has a 30-
minute requirement before it can be billed.
About MedicalBillersandCoders
For a detailed understanding of billing for Chronic Care Management Services, you can refer MLN document
. Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue
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2022 Revised Codes for Principal Care Management
cycle services. We can assist you in receiving accurate insurance reimbursements for Chronic Care Management 
(CCM) and Principal Care Management (PCM). To learn more about our medical billing and coding services, 
contact us at [email protected]/ 888-357-3226
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