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Principal Care Management (PCM) Update for 2020 – What to Know

The Centers for Medicare and Medicaid Services (CMS) has recently introduced two reimbursement processes under Principal Care Management (PCM) this 2020. These processes may appear similar to the current Chronic Care Management (CCM) program offered by Medicare, but it has a few key differences. If you want to understand them

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Profit Calculator Assumptions: 40% of total Medicare patients enrolling is based on (i) Medicare Chart Book’s data showing that ~68% of medicare patients qualify for CCM (2 or more chronic conditions), and (ii) that ~40% of eligible patients will enroll.

For typical providers, $46.67 of net profit per patient per month is based on a Medicare reimbursement per patient per month (national average) for various care management CPT codes.

CPT and other codes, descriptions and other data are copyright 2011 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association (AMA).