In value-based care, patient outcomes depend on more than what happens in the exam room. Coordinated care, consistent communication, and proactive management are crucial for enhancing health outcomes and reducing healthcare costs. Two important programs supporting these goals are Chronic Care Management (CCM) and Principal Care Management (PCM). Although similar, they serve different purposes within care delivery.
What is CCM?
Chronic Care Management is designed for patients having two or more chronic conditions expected to last at least 12 months or until death. These conditions place the patient at a significant risk of death, acute exacerbation, or functional decline.
CCM focuses on comprehensive, ongoing coordination of care across all patient needs. Services typically include:
- Developing and updating a comprehensive care plan
- Managing medications and adherence
- Coordinating with specialists and community resources
- Regular check-ins by care team members
Providers can bill for at least 20 minutes of non-face-to-face care per month. CCM rewards practices that stay connected to patients between visits, helping reduce hospitalizations and improve overall quality of life.
What is PCM?
Principal Care Management supports patients with a single complex or high-risk chronic condition that requires continuous management. PCM is a good fit for patients needing intensive focus on one condition, such as congestive heart failure, COPD, or diabetes with complications.
PCM services include:
- Establishing and monitoring a disease-specific care plan
- Providing frequent communication and care coordination
- Supporting medication management and adherence
- Educating the patient and caregivers about self-management
Like CCM, PCM is a time-based code, billed based on the time spent managing a patient’s care outside of face-to-face visits. PCM allows specialists or PCPs to focus deeply on one condition, ensuring patients receive the right level of support.
| Feature | CCM | PCM |
| Number of Conditions | Two or More | One |
| Focus | Whole Person Care | Condition Specific Care |
| Time Requirement | At least 20 minutes per month | At least 30 minutes per month |
| Goal | Improve overall health and coordination | Improve management of a single condition |
Billing and Documentation
Providers must meet specific requirements to ensure compliance and reimbursement for CCM and PCM. Patients must provide verbal or written consent for enrollment in either program, and only one clinician can bill for CCM or PCM services for a patient during a given month. Detailed time tracking and consistent documentation of care activities help practices stay compliant and reduce the risk of denied claims.
For CCM:
- Use CPT codes 99490, 99439, 99487, or 99489, depending on the level of complexity and time spent.
- Document at least 20 minutes of non-face-to-face care coordination each month.
- Maintain a comprehensive, patient-centered care plan.
For PCM:
- Use CPT codes 99424, 99425, 99426, or 99427 based on the time and type of provider involved.
- Document at least 30 minutes of care coordination focused on a single complex condition.
- Ensure the care plan outlines treatment goals, medication management, and patient education related to the target condition.
Choosing the Right Program
When deciding between CCM and PCM, consider the patient’s overall health. A patient with multiple chronic diseases will have maximum benefit from CCM, which takes a whole-person approach. A patient struggling with one complex condition may gain more from PCM, where the care team can focus on targeted interventions.
Both programs strengthen patient relationships and improve health outcomes. By incorporating chronic care management and principal care management into workflows, providers can deliver more consistent, coordinated, and compassionate care.