The Centers for Medicare and Medicaid Services (CMS) released a program in 2020 called Principal Care Management (PCM), open to primary care providers and specialists. This program was specially developed to serve people with one chronic condition, supplementary to the Chronic Care Management (CCM) program (which focuses on two or more chronic conditions). With PCM, patients who fit the category could get the care they need more affordably and efficiently. It can also benefit the providers in many ways.

This article will help you understand what the program is about and why it is an excellent health program to partake in.

What Is Principal Care Management?

Years back, it was only CMS services that were reimbursable. The program was also limited to people with two or more chronic conditions. For that reason, PCM was developed to cater to more people.

According to the Centers for Disease Control and Prevention (CDC), six out of ten people in the US have at least one chronic disease. With this program, Medicare aims to encourage millions of Americans with one chronic disease to seek the medical monitoring, assistance, and service they need.

However, since the program is relatively new, many providers are willing to offer this service to their medical institution.

What Is It for the Patients: The Benefits

  • With the help of the PCM, more patients can go for checkups resulting in better health. It can help them stabilize their chronic condition as promptly as possible.
  • With a more stable condition, they can reduce their health expenses. At the same time, the program is backed by Medicare, reducing the patient’s healthcare costs.
  • In the CCM program, patients can feel more valued and safe. The same engagement is expected for the PCM program.

What Is It for the Providers: The Benefits

  • The national budget for annual health care expenditures in the US is $3.5 trillion, and according to the CDC, 90 percent of this budget is dedicated to people with chronic and mental health conditions.
  • Offering PCM could help more patients improve their health. Early addressing of health concerns could prevent a second chronic condition from occurring.

The Requirements

The requirements to qualify for PCM are somehow similar to the CCM:

  • The patient’s diagnosis should last between three to twelve months or until the end of their lives.
  • Their diagnosis should have led to a recent hospitalization, a high risk of death, or functional decline.
  • The patient should have provided their consent either in written or verbal form.
  • The only difference between the PCM and CCM is its time requirement for billing. PCM needs a 30-minute condition before the service can get billed, while CCM only needs 20 minutes.

Reimbursement Opportunities for Providers

To support PCM, the CMS has approved two new CPT codes: G2064 and G2065, to help them maximize the revenue of their practices.

CPT Code: G2064

  • The bill for 30 minutes of the physician’s time per month is worth $78.68 per patient.
  • Each practice should provide comprehensive care management services with at least 30 minutes of their time with a complex condition.

CPT Code: G2065

  • The bill for 30 minutes of the clinical/provider staff’s time per month worth $39.70 per patient
  • Each practice should provide comprehensive care management services with at least 30 minutes of clinical time as directed by the healthcare professional every calendar month.

To know more about the CPT codes, read this comprehensive explanation.


The PCM is a health program created to benefit both the patients and providers. With chronic care management programs like this, people can improve their health while creating revenue opportunities for the providers.

Should you need further assistance with preventive care, Medistics Health is here to assist. We aim to simplify patient care by providing a dedicated care manager who can schedule appointments, refill medication, remotely monitor vitals and other services. Contact us today so we can help you.

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).