When it comes to caring for patients with chronic health issues, you cannot go with one size fits all. That is why Medicare offers different care management programs to support patients outside the clinic. Two of the most commonly used, but often misunderstood, programs are Principal Care Management (PCM) and Chronic Care Management (CCM). 

While you may think that they are similar, they serve different purposes and guidelines. If you are a healthcare provider who is looking to offer better care while boosting the revenue of your practice, it is important to understand PCM vs. CCM. This blog is your ultimate guide to understanding this. Let’s explore this.

What Is Chronic Care Management (CCM)?

Chronic Care Management (CCM) is a Medicare-supported program that helps healthcare providers support patients who are living with two or more chronic health conditions. These conditions, such as diabetes, heart disease, arthritis, or COPD, are long-term and often require ongoing attention beyond routine office visits. 

With CCM, providers can offer continuous, personalized care by checking in regularly with patients, managing medications, coordinating with specialists, and updating care plans. 

The goal of CCM is to help patients stay healthier and feel more in control of their health. Under this program, providers are reimbursed for spending at least 20 minutes per month on non-face-to-face care management activities. For example, phone calls and reviewing test results. 

Patients benefit from improved communication and proactive support, while providers can offer better outcomes and earn additional revenue. CCM is a win-win for improving long-term care outside the clinic.

What Is Principal Care Management (PCM)?

Principal Care Management (PCM) is a Medicare-backed program designed for patients who have one serious chronic condition that significantly impacts their daily life or health. Unlike Chronic Care Management (CCM), which requires two or more chronic conditions, PCM focuses on providing targeted support for just one complex issue, like advanced diabetes or heart failure.

PCM allows healthcare providers to deliver ongoing, structured care outside of regular office visits. This includes services like care coordination, medication management, monthly check-ins, and creating a care plan that focuses on that single condition. The goal is to prevent complications and reduce hospital visits.

Generally, PCM is managed by specialists who are primarily responsible for the patient’s condition, though primary care providers can also bill for it if they are the main caregiver. PCM offers patients more focused support and gives providers a way to be reimbursed for the extra care they’re already providing.

Key Differences Between PCM and CCM

Before going into details of PCM vs. CCM, here is a table covering all the main points. 
 

Feature	Principal Care Management (PCM)	Chronic Care Management (CCM)
Number of Conditions	1 chronic condition	2 or more chronic conditions
Care Management Focus	Focused on one specific condition	Holistic care for multiple conditions
Typical Billing Providers	Specialists (e.g., cardiologists, endocrinologists)	Primary care providers (e.g., family doctors, internists)
Care Plan Scope	Focused care plan for a single condition	Comprehensive plan covering all chronic conditions
Time Requirement	Minimum 20 mins/ month (non-face-to-face)	20 mins/ month minimum; higher codes available for more time
Consent Requirement	Verbal consent, documented	Written or verbal consent (written preferred)
Ideal Patient Profile	Patients with one serious, high-impact chronic condition	Patients with multiple, long-term chronic conditions
Staffing Needs	Small care team (e.g., nurse or care coordinator)	Larger team, may involve third-party support
Technology Usage	Care tracking and EHR helpful but simpler setup	Requires more robust technology for coordination and tracking

Number of Chronic Conditions

PCM is for patients who have only one serious chronic condition that is expected to last at least three months and has a significant impact on their health or daily life. The idea is to provide focused attention on managing that one issue.

CCM, on the other hand, is for patients with two or more chronic conditions that are expected to last a year or longer and put them at significant risk of health decline or death. These patients need a broader approach that looks at how their conditions interact.

So, if a patient has just one major issue, like severe COPD, they might qualify for PCM. If they also have diabetes or heart disease, they are better suited for CCM.

Care Management Focus

In PCM, the provider zeroes in on managing a single condition. All care coordination, medication management, and communication revolve around that one problem. It is about doing one thing very well.

CCM requires a more holistic approach. If you are a provider, you need to consider how two or more conditions affect each other and how to create a care plan that keeps everything in sync. This often means more moving parts and more coordination with specialists.

Types of Providers Who Can Bill

PCM is mostly billed by specialists. For example, a cardiologist managing a patient’s congestive heart failure or an endocrinologist overseeing diabetes care. The program is designed for situations where a specialist is playing the lead role in managing one key condition.

CCM is more often billed by primary care providers, like family doctors or internists. These providers take a big-picture view and are usually responsible for overseeing all of a patient’s chronic conditions.

That said, there is flexibility. A primary care provider could bill for PCM if they are the main clinician managing that condition. The key is whether the provider is principally responsible for managing the patient’s condition.

Care Plan Requirements

For PCM, the care plan focuses solely on the single chronic condition being managed. It outlines treatment goals, medications, symptom monitoring, and any lifestyle changes needed. The plan is straightforward and centered around one issue.

CCM care plans need to address each of the patient’s chronic conditions, how they affect one another, and how to manage them together. 

Time and Documentation Requirements

For both PCM and CCM, providers must spend a minimum of 20 minutes per month on non-face-to-face care management activities. This includes things like phone calls, reviewing lab results, coordinating with other providers, and updating care plans.

However, CCM also offers additional billing codes if more time is spent, such as 40 or 60 minutes per month. This gives providers flexibility to get reimbursed for the extra effort it takes to manage multiple conditions.

Consent and Patient Enrollment

With PCM, verbal consent is enough, but it must be documented in the patient’s chart. Patients need to understand what the service includes and that it may involve a small monthly copay.

CCM requires written or verbal consent, but written is preferred. Providers must explain the nature of the service, potential costs, and ensure that only one provider is billing for CCM services each month.

Who Benefits the Most?

PCM is best suited for specialist-driven care or for patients with a dominant, high-risk condition. It is ideal for cases where managing that one condition well can drastically improve outcomes.

CCM benefits patients who need a team approach. These are often older adults with multiple health challenges who require careful medication management and regular monitoring.

Staffing and Workflow Considerations

To run either program effectively, providers need a solid workflow and the right staff. PCM can often be managed with a small team, like a nurse or care coordinator who checks in with patients monthly, logs activities, and updates the care plan.

CCM usually requires a more robust setup, with several team members handling scheduling, medication reviews, communication with specialists, and patient education. Some practices outsource CCM to third-party vendors to handle the heavy lifting.

When to Use PCM vs. CCM

Wondering when it is best to use PCM vs. CCM? A direct answer to this would be that it depends on the condition of the patient and the role of the provider in their care. A more detailed answer is given below. 

You can use PCM (Principal Care Management) when a patient has only one serious chronic condition that requires them to get focused, ongoing management. This is ideal when that one condition, like diabetes or asthma, is the primary health concern that is affecting the quality of life of the patient. PCM can also be a good fit when a specialist is the main provider who is managing the patient’s care for that single issue. 

On the other hand, you can use CCM (Chronic Care Management) when a patient has two or more chronic conditions that are expected to last at least a year and create a higher risk of health decline or hospitalization. CCM can be best for primary care providers who are responsible for coordinating all aspects of a patient’s health. It is the right choice for patients who need broad support with multiple conditions and medications. 

There are certain cases where a patient might start with PCM and later move to CCM if another condition develops. 

Reimbursement Considerations

When doctors provide PCM or CCM, they are offering services that may happen outside of regular face-to-face visits. For chronic care management (CCM), common CPT codes include 99490 for the initial 20 minutes of clinical staff time per month. If more time is needed, an add-on code like 99239 might be used for each additional 20 minutes. 

For more involved cases, known as complex CCM, codes like 99489 (for the first 60 minutes of clinical staff time) and 99489 (for additional 30-minute blocks) come into play. 

Principal Care Management (PCM) is a little different as it focuses on managing one complex chronic condition. For PCM services provided by clinical staff under the direction of a doctor, CPT code 99426 is often used for the first 30 minutes per month, with 99427 (for the first 30 minutes) and 99425 (for additional 30-minute increments). 

Reimbursement rates vary based on complexity and time spent, following Medicare’s current guidelines.

In both cases, make sure that accurate documentation of time and activities is being done. Medicare requires clear records of what was done, when, and by whom.

Conclusion

PCM and CCM offer their ways to support patients beyond the office visit. While PCM focuses on managing one chronic condition, CCM covers multiple with a more holistic, team-based approach. Both have their own benefits and billing rules. 

In order to make an informed decision, it is better to understand the differences between and improve patient outcomes. 

If you are looking for a remote patient monitoring provider, Tellihealth is one of the best in the business. It offers an end-to-end virtual care platform that integrates directly with your EHR. It helps you save time and have better compliance with Medicare billing requirements. 

Frequently Asked Questions (FAQs)

What is the main difference between PCM and CCM?

The key difference lies in the number of conditions managed. Principal Care Management (PCM) focuses on one serious chronic condition, while Chronic Care Management (CCM) supports patients with two or more chronic conditions that require continuous attention and coordination.

Who can bill for PCM and CCM services?

PCM is typically billed by specialists who manage a patient’s primary condition, such as cardiologists or endocrinologists. CCM is generally billed by primary care providers who oversee all of a patient’s chronic conditions, though specialists can also bill if they coordinate overall care.

Can a patient receive both PCM and CCM services?

Yes, but not at the same time for the same condition. A patient may start under PCM for one serious condition and later transition to CCM if they develop additional chronic conditions requiring broader management.

How much time is required each month for PCM and CCM billing?

Both programs require a minimum of 20 minutes per month of non-face-to-face care coordination. However, CCM offers higher billing codes for extended time (40 or 60 minutes), allowing providers to bill more for complex cases.

Do providers need patient consent for PCM or CCM?

Yes. PCM requires verbal consent documented in the patient’s record, while CCM requires written or verbal consent, with written preferred for compliance.

What type of patients benefit most from PCM?

PCM is ideal for patients with one high-impact chronic condition, such as severe COPD, heart failure, or advanced diabetes, where focused management can significantly improve outcomes and prevent hospitalizations.

What type of patients are best suited for CCM?

CCM works best for patients with multiple long-term conditions, such as diabetes, hypertension, and arthritis, who need coordinated care across multiple providers and medications.

How do PCM and CCM integrate with Remote Patient Monitoring (RPM)?

PCM and CCM complement Remote Patient Monitoring (RPM) by extending care between visits. While RPM captures real-time data, PCM and CCM ensure that information is reviewed, acted on, and documented for Medicare compliance and better outcomes.

How can providers implement PCM or CCM efficiently?

Partnering with an experienced care management vendor like Tellihealth helps streamline enrollment, automate documentation, ensure compliance, and increase revenue while improving patient outcomes.