Principal care management (PCM) is the single-condition counterpart to CCM. Where chronic care management requires two or more chronic conditions, PCM covers monthly management of one high-risk condition. Per the CMS care management booklet (MLN909188), the condition must be expected to last at least three months and place the patient at significant risk of hospitalization, acute exacerbation or decompensation, functional decline, or death.
The four codes and 2026 rates
PCM has two lanes, exactly like CCM: one for the practitioner’s personal time and one for clinical staff time. All figures are 2026 national non facility amounts, before geographic adjustment.
- CPT 99424: first 30 minutes of physician or QHP personal time per month. $87.51. Limited to 1 unit per date of service.
- CPT 99425: each additional 30 minutes of practitioner time. $61.46. Up to 2 units, adjudicated as a clinical edit.
- CPT 99426: first 30 minutes of clinical staff time per month, under the practitioner’s general supervision. $67.80. Limited to 1 unit.
- CPT 99427: each additional 30 minutes of clinical staff time. $54.11. Up to 2 units, adjudicated as a clinical edit.
The rules that trip practices up
There is a hard monthly floor: CMS states you cannot bill PCM for less than 30 minutes in a calendar month. A month that ends at 25 documented minutes bills nothing. There is also a renewal clock: after one year of PCM, another initiating visit is required to continue the service. And as with CCM, you pick one lane for the month, the practitioner codes or the staff codes, based on who actually did the work; CPT instructs against mixing them within a month.
On concurrency, the same practitioner cannot bill CCM and PCM for the same patient in the same month. Different practitioners can: a primary care practice can bill CCM for the whole patient while a specialist bills PCM for the one condition it manages, each with its own care plan, and the conditions each service addresses must be different. PCM’s care plan may be specific to that single disease rather than comprehensive.
Why specialists should care
PCM is the care management entry point for practices that manage one condition deeply rather than the whole patient: cardiology with heart failure, pulmonology with COPD, orthopedics and physiatry with severe joint disease. The eligibility test is condition risk, not condition count, and the monthly work is the follow up, medication coordination, and care plan management those practices already do without billing for it.
PCM is not affected by the CY 2027 proposed rule on remote monitoring staffing; that proposal covers RPM and RTM only. Our breakdown of what the 2027 proposal actually covers has the details.
Practice Management Consultancy helps practices build PCM and CCM programs staffed by their own team, from eligibility analysis through the first billing cycles. Start with a care management assessment.
Sources
- CMS, Chronic Care Management Services, MLN909188 (June 2025), PCM section
- CMS, CCM Billing FAQ (updated 8/16/2022), CCM and PCM concurrency
- CMS Physician Fee Schedule Relative Value File, July 2026 release (rates are 2026 national non facility amounts, nonqualifying APM conversion factor, before locality adjustment)
- CMS NCCI Medically Unlikely Edits, practitioner table effective 07/01/2026
