PCM is built for patients with a single, complex chronic condition who need ongoing, disease-specific management between visits. CareSpace turns the work you already do between appointments into a recurring, compliant revenue stream.
Principal Care Management reimburses the ongoing, between-visit work of managing a patient's single high-acuity chronic condition — the disease-specific care that specialists already deliver but rarely get paid for. It's the natural counterpart to Chronic Care Management.
For patients with two or more chronic conditions expected to last 12+ months. Typically owned by the primary care team coordinating the whole patient.
For patients with a single, complex condition needing focused, disease-specific management — ideal for the specialist who owns that condition between visits.
Adherence & compliance, sustained. Continuous management keeps patients on their treatment plan and medications between appointments — where most complex conditions actually drift.
Specialist ↔ PCP coordination. PCM formalizes the handoff loop, so the specialist managing the condition and the primary care team stay aligned on one shared plan.
Between-visit work becomes recurring revenue. The outreach, monitoring and plan adjustments you already do are captured to the correct PCM code — every month.
medication adherence sustained across actively managed PCM patients
of monthly disease-specific care time captured per enrolled patient
tighter specialist-to-PCP coordination on one shared care plan
typical recurring reimbursement per patient, per managed condition
PCM is billed monthly per managed condition. Physician/QHP time and clinical-staff time each have their own code pair, so every minute lands where it belongs.
Stack the base code with its add-on for longer months. A single complex condition under active management typically reimburses around $80 per patient, per month — recurring.
First 30 minutes of physician or qualified provider time, per calendar month.
Each additional 30 minutes of physician or QHP time within the month.
First 30 minutes of clinical staff time, directed by the provider, per month.
Each additional 30 minutes of clinical staff time within the month.
Take 150 heart-failure patients under active monthly PCM. The between-visit work you already do — captured to the right code — compounds into a predictable line of recurring revenue, with no new appointments required.
Model your own panel →If your practice owns a single complex condition between visits, PCM was written for you. See the full picture on our solutions overview.
Congestive heart failure and other complex cardiac conditions managed month to month.
Ongoing COPD management — keeping high-risk respiratory patients stable between visits.
Complex diabetes requiring continuous, disease-specific titration and adherence support.
Chronic kidney disease (CKD) managed across stages with tight medication oversight.
Active surveillance and survivorship care for a single principal oncologic condition.
Complex autoimmune & inflammatory disease needing continuous, focused management.
From flagging the right patients to coding the right minutes — CareSpace carries the operational weight so your team stays on the condition.
CareSpace scans your panel for single-condition complex patients who qualify for PCM — surfacing eligibility without manual chart review.
A disease-specific care plan is generated for that one complex condition, then kept current as the patient's status changes between visits.
The PCP stays looped in on one shared plan while staff and physician time is captured automatically to the correct PCM code — 99424–99427.
See how CareSpace flags eligible patients, builds condition-specific plans and codes every minute to the right PCM code — automatically. A 20-minute demo is all it takes.