Table III.

Principal care management (PCM)

Service summary	Current Procedural Terminology code	Description	2022 work relative value units/practice expense relative value units (NF/F)	2022 physician fee schedule (national average)
•Verbal consent •Initiating visit •Certified EHR •24/7 access “on call service” •Designated care team member •Disease-specific care management •Disease-specific electronic care plan •Management of care transitions/referrals •Home and community-based care coordination •Enhanced communication opportunities	99424	PCM services for single high-risk disease. First 30 min provided personally by physician or other qualified health care professional, per calendar month	1.45/0.86/0.63	NF: $83.40 F: $75.44
	99425	PCM services for single high-risk disease. Each additional 30 min provided personally by physician or other qualified health care professional, per calendar month	1.00/0.66/0.44	NF: $60.22 F: $52.60
	99426	PCM services for single high-risk disease. First 30 min of clinical staff time directed by physician or other qualified health care professional, per calendar month	1.00/0.75/0.38	NF: $63.33 F: $50.53
	99427	PCM services for single high-risk disease. Each additional 30 min of clinical staff time directed by physician or other qualified health care professional, per calendar month	0.71/0.64/0.27	NF: $48.45 F: $35.64

F, facility; NF, non-facility.

Requirements include one complex chronic condition lasting at least 3 mo, which is the focus of the care plan. The condition is of sufficient severity to place the patient at risk for hospitalization or to have been the cause of a recent hospitalization. The condition requires the development or revision of a disease-specific care plan. The condition also requires frequent adjustments in the medication regimen and/or management of the condition is unusually complex owing to comorbidities.